Kashkoush Ahmed, El-Abtah Mohamed E, Srivatsa Shaarada, Desai Ansh, Davison Mark, Achey Rebecca, Mahapatra Ashutosh, Patterson Thomas, Moore Nina, Bain Mark
1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and.
2Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Neurosurg. 2022 Nov 4;138(6):1487-1493. doi: 10.3171/2022.10.JNS221138. Print 2023 Jun 1.
Woven EndoBridge (WEB) intrasaccular flow disruptors and stent-assisted coiling (SAC) are viable endovascular treatment options for wide-neck bifurcation intracranial aneurysms (WNBAs). Data directly comparing these two treatment options are limited. The authors aimed to compare radiographic occlusion rates and complication profiles between patients who received WEB and those who received SAC for WNBAs.
Retrospective review of a prospectively maintained cerebrovascular procedural database was performed at a single academic medical center between 2017 and 2021. Patients were included if they underwent WEB embolization or SAC of an unruptured WNBA. SAC patients were propensity matched to WEB-embolized patients on the basis of aneurysm morphology. Complete and adequate (complete occlusion or residual neck remnant) occlusion rates at last angiographic follow-up, as well as periprocedural complications, were compared between the two groups. A cost comparison was performed for a typical 5-mm WNBA treated with WEB versus SAC by using manufacturer-suggested retail prices.
Thirty-five WEB and 70 SAC patients were included. Aneurysm width, neck size, and dome-to-neck ratio were comparable between groups. Follow-up duration was significantly longer in the SAC group (median [interquartile range] 545 [202-834] days vs 228 [177-494] days, p < 0.001, Mann-Whitney U-test). Complete (66% of WEB patients vs 69% of SAC patients) and adequate (94% WEB vs 91% SAC) occlusion rates were similar between groups at the last available angiographic follow-up (p = 0.744, chi-square test). Complete occlusion rates were comparable on Cox regression analysis after correction for follow-up duration (hazard ratio 1.5, 95% CI 0.8-3.1). Average time to residual aneurysm or neck formation was not statistically different between treatment groups (613 days for SAC patients vs 347 days for WEB patients, p = 0.225, log-rank test). Periprocedural complications trended higher in the SAC group (0% WEB vs 9% SAC, p = 0.175, Fisher exact test), although this finding was not significant. The equipment costs for a typical SAC case were estimated at $18,950, whereas the costs for a typical WEB device case were estimated at $18,630.
Midterm complete and adequate occlusion rates were similar between patients treated with WEB and those treated with SAC. Given these comparable outcomes, there may be equipoise in treatment options for WNBAs.
编织型血管内桥接器（WEB）瘤内血流干扰装置和支架辅助弹簧圈栓塞术（SAC）是治疗宽颈分叉部颅内动脉瘤（WNBA）可行的血管内治疗选择。直接比较这两种治疗选择的数据有限。作者旨在比较接受WEB治疗和接受SAC治疗的WNBA患者的影像学闭塞率和并发症情况。
在2017年至2021年期间，于一家学术医疗中心对前瞻性维护的脑血管手术数据库进行回顾性研究。纳入接受未破裂WNBA的WEB栓塞或SAC治疗的患者。根据动脉瘤形态，将SAC组患者与接受WEB栓塞的患者进行倾向匹配。比较两组在最后一次血管造影随访时的完全和充分（完全闭塞或残留颈部残余）闭塞率以及围手术期并发症。使用制造商建议零售价对典型的5mm WNBA采用WEB与SAC治疗进行成本比较。
纳入35例接受WEB治疗和70例接受SAC治疗的患者。两组间动脉瘤宽度、颈部大小和瘤顶与颈部比例具有可比性。SAC组的随访时间显著更长（中位数[四分位间距]545[202 - 834]天 vs 228[177 - 494]天，p < 0.001，Mann - Whitney U检验）。在最后一次可用血管造影随访时，两组间的完全闭塞率（WEB组66% vs SAC组69%）和充分闭塞率（WEB组94% vs SAC组91%）相似（p = 0.744，卡方检验）。校正随访时间后，Cox回归分析显示完全闭塞率具有可比性（风险比1.5，95%CI 0.8 - 3.1）。治疗组间残余动脉瘤或颈部形成的平均时间无统计学差异（SAC组患者为613天，WEB组患者为347天，p = 0.225，对数秩检验）。围手术期并发症在SAC组有升高趋势（WEB组0% vs SAC组9%，p = 0.175，Fisher精确检验），尽管这一发现无统计学意义。典型SAC病例的设备成本估计为18,95美元，而典型WEB装置病例的成本估计为18,630美元。
接受WEB治疗和接受SAC治疗的患者中期完全和充分闭塞率相似。鉴于这些可比的结果，WNBA的治疗选择可能存在 equipoise。
