Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
Neurosurgery. 2021 Mar 15;88(4):779-784. doi: 10.1093/neuros/nyaa539.
Intrasaccular flow-disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms.
To retrospectively compare Woven Endobridge (WEB) embolization with microsurgical clipping for unruptured anterior circulation aneurysms using propensity score adjustment.
A total of 63 patients treated with WEB and 103 patients treated with clipping were compared based on the intention-to-treat principle. The primary outcome measures were immediate technical treatment success, major adverse events, and 6-mo complete aneurysm occlusion.
The technical success rates were 83% for WEB and 100% for clipping. Procedure-related complications occurred more often in the clipping group (13%) than the WEB group (6%, adjusted P < .01). However, the rates of major adverse events were comparable in both groups (WEB: 3%, clip: 4%, adjusted P = .53). At the 6-mo follow-up, favorable functional outcomes were achieved in 98% of the WEB embolization group and 99% of the clipping group (adjusted P = .19). Six-month complete aneurysm occlusion was obtained in 75% of the WEB group and 94% of the clipping group (adjusted P < .01).
Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in ≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient's preferences.
血管内腔内血流阻断技术代表了一种治疗宽颈分叉部动脉瘤的新方法。
采用倾向性评分调整，回顾性比较 Woven Endobridge（WEB）栓塞与显微夹闭治疗未破裂前循环动脉瘤的效果。
根据意向治疗原则，比较了 63 例接受 WEB 治疗和 103 例接受夹闭治疗的患者。主要观察指标为即刻技术治疗成功率、主要不良事件和 6 个月完全动脉瘤闭塞。
WEB 组的技术成功率为 83%，夹闭组为 100%。夹闭组的手术相关并发症发生率（13%）明显高于 WEB 组（6%，调整后 P<.01）。但是，两组的主要不良事件发生率相当（WEB 组：3%，夹闭组：4%，调整后 P=0.53）。6 个月随访时，WEB 栓塞组 98%和夹闭组 99%的患者获得了良好的功能结局（调整后 P=0.19）。WEB 组 6 个月完全动脉瘤闭塞率为 75%，夹闭组为 94%（调整后 P<.01）。
显微夹闭技术与更高的技术成功率和完全闭塞率相关，而 WEB 技术的并发症发生率较低。两组患者的功能结局均达到了≥98%。具体治疗方式的选择应根据患者的个体情况和偏好而定。
