Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany.
Institute of Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, Munich, 81377, Germany.
Sci Rep. 2024 Oct 16;14(1):24212. doi: 10.1038/s41598-024-75064-2.
Intrasaccular flow disruption with the Woven Endobridge (WEB) has become a well-established endovascular technique for the treatment of intracranial aneurysms. This study presents our 12-year experience with the WEB and evaluates its evolving indications, procedures, and outcomes. A consecutive series of 324 aneurysms treated with WEB between 2011 and 2023 at three neurovascular centers was retrospectively analyzed and the study group was divided into four treatment periods. Uni- and multivariate analyses were performed to evaluate factors associated with technical success, thromboembolic complications, and angiographic outcome. The mean aneurysm size was 7.0 ± 3.6 mm and decreased during the study period, while the proportion of atypical sites for WEB implantation increased. WEB implantation was technically successful in 96.0%, and the ratio of WEB width to dome width increased during the study period, indicating oversizing. The neurological complication rate was 4.9% (1.5% major, 3.4% minor) and the mid-term complete occlusion rate was 60.6% (81.9% adequate occlusion), with no statistical differences in either outcome measure between the study periods. In multivariate analyses, the use of WEB 17 was associated with increased technical success (HR: 7.4, 95%CI: 2.4-23.6, p<0.01), whereas ruptured aneurysm status (HR: 2.5, 95%CI: 1.0-6.0, p=0.04) and the use of additional stents (HR: 4.8, 95%CI: 1.6-14.4, p<0.01) predicted thromboembolic complications. Appropriate oversizing of the WEB favored mid-term complete occlusion (HR: 10.5, 95%CI: 1.3-83.3, p=0.03). The results suggest an expansion of the indications for WEB implantation and highlight the importance of oversizing for treatment efficacy.
颅内血管内血流阻断技术（WEB）已成为治疗颅内动脉瘤的一种成熟的血管内治疗技术。本研究介绍了我们使用 WEB 的 12 年经验，并评估了其不断发展的适应证、手术过程和结果。回顾性分析了 2011 年至 2023 年期间在三个神经血管中心使用 WEB 治疗的 324 个动脉瘤，将研究组分为四个治疗期。采用单因素和多因素分析评估与技术成功、血栓栓塞并发症和血管造影结果相关的因素。平均动脉瘤大小为 7.0±3.6mm，且在研究期间减小，而 WEB 植入的非典型部位比例增加。WEB 植入技术成功率为 96.0%，且 WEB 宽度与瘤颈宽度的比值在研究期间增加，表明过度扩张。神经并发症发生率为 4.9%（1.5%为主要并发症，3.4%为次要并发症），中期完全闭塞率为 60.6%（81.9%为充分闭塞），各研究期之间在这两个结果指标上均无统计学差异。多因素分析显示，使用 WEB 17 与技术成功率增加相关（HR：7.4，95%CI：2.4-23.6，p<0.01），而动脉瘤破裂状态（HR：2.5，95%CI：1.0-6.0，p=0.04）和使用附加支架（HR：4.8，95%CI：1.6-14.4，p<0.01）预测血栓栓塞并发症。WEB 的适当过度扩张有利于中期完全闭塞（HR：10.5，95%CI：1.3-83.3，p=0.03）。结果表明 WEB 植入适应证扩大，并强调了过度扩张对治疗效果的重要性。
