1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and.
2Department of Physics, University of Toronto, Ontario, Canada.
J Neurosurg. 2022 Apr 29;137(6):1786-1793. doi: 10.3171/2022.3.JNS2217. Print 2022 Dec 1.
Stent-assisted coil (SAC) embolization has been the mainstay endovascular treatment for bifurcation aneurysms. The recent introduction of the Woven EndoBridge (WEB) device has presented an alternative endovascular treatment modality for these aneurysms. Direct comparisons of outcomes between these two modalities are limited in the literature. Here, the authors compared the outcomes of bifurcation aneurysms treated with SAC and WEB devices.
This retrospective single-center study comprised 148 bifurcation aneurysms that were treated endovascularly with SAC or WEB devices between 2011 and 2019. The primary outcome was complete occlusion of the aneurysm at 6 months on catheter angiography.
The SAC and WEB cohorts comprised 85 and 63 aneurysms, respectively. The baseline characteristics were well balanced after inverse probability weight (IPW) adjustment, except for smoking status. The 6-month complete occlusion rate was higher in the WEB cohort than the SAC cohort (67.4% vs 40.6%; unadjusted OR [95% CI] 3.014 [1.385-6.563], p = 0.005). However, this difference in complete occlusion rates did not remain significant after IPW adjustment and multiple imputations. The neck remnant rate was lower in the WEB cohort than the SAC cohort (20% vs 50%; OR [95% CI] 0.250 [0.107-0.584], p = 0.001), and this difference remained significant after IPW adjustment (OR [95% CI] 0.304 [0.116-0.795], p = 0.015) and multiple imputations.
Use of SAC and WEB demonstrated comparable 6-month complete occlusion rates for bifurcation aneurysms. WEB appeared to be associated with a lower rate of neck remnant at 6 and 12 months compared with SAC. WEB was also associated with fewer complications and decreased retreatment rates compared with SAC.
支架辅助线圈（SAC）栓塞已成为治疗分叉动脉瘤的主要血管内治疗方法。最近引入的编织式 EndoBridge（WEB）装置为这些动脉瘤提供了另一种血管内治疗方法。这两种方法的结果直接比较在文献中有限。在这里，作者比较了 SAC 和 WEB 装置治疗分叉动脉瘤的结果。
这项回顾性单中心研究纳入了 2011 年至 2019 年间接受 SAC 或 WEB 装置血管内治疗的 148 个分叉动脉瘤。主要结局是导管血管造影 6 个月时动脉瘤完全闭塞。
SAC 和 WEB 队列分别包括 85 个和 63 个动脉瘤。经过逆概率加权（IPW）调整后，除吸烟状况外，基线特征平衡良好。WEB 队列的 6 个月完全闭塞率高于 SAC 队列（67.4%比 40.6%；未调整的 OR [95%CI] 3.014 [1.385-6.563]，p = 0.005）。然而，在 IPW 调整和多重插补后，完全闭塞率的差异不再显著。WEB 队列的瘤颈残留率低于 SAC 队列（20%比 50%；OR [95%CI] 0.250 [0.107-0.584]，p = 0.001），并且在 IPW 调整（OR [95%CI] 0.304 [0.116-0.795]，p = 0.015）和多重插补后，这种差异仍然显著。
SAC 和 WEB 的使用对于分叉动脉瘤显示出可比的 6 个月完全闭塞率。与 SAC 相比，WEB 在 6 个月和 12 个月时瘤颈残留率较低。与 SAC 相比，WEB 还与更少的并发症和降低的再治疗率相关。
