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Publications

Journal Article Ahead of print

PubMed: 42711440 DOI: 10.1007/s00330-026-12840-w

Smaller WEB devices show lower retreatment rates than larger devices: results from the WorldWideWEB study.

Eur Radiol

Authors: Franja Dugar, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Mahmoud Dibas, Davide Simonato, Yan-Lin Li, Muhammed Amir Essibayi, Oktay Algin, Sherief Ghozy, Sovann V Lay, Adrien Guenego, Leonardo Renieri, Joseph Carnevale, Guillaume Saliou, Panagiotis Mastorakos, Eimad Shotar, Markus Möhlenbruch, Michael Kral, Charlotte Chung, Mohamed M Salem, Ivan Lylyk, Paul M Foreman, Hamza Shaikh, Vedran Župančić, Muhammad U Hafeez, Joshua Catapano, Muhammad Waqas, Ahmet Gurhan Gurcay, Giyas Ayberk, Muhammet Arslan, James D Rabinov, Onur Ergun, Julian Maingard, Clemens M Schirmer, Mariangela Piano, Anna L Kühn, Caterina Michelozzi, Robert M Starke, Ameer Hassan, Mark Ogilvie, Jesse Jones, Waleed Brinjikji, Marios Psychogios, Marie T Nawka, Jens Fiehler, Thi Dan Linh Nguyen-Kim, Bryan Pukenas, Jan-Karl Burkhardt, Thien Huynh … and 35 other authors

Affiliations

  • Department of Radiology, Neuroradiology and Nuclear Medicine, Stadtspital Zurich, Zurich, Switzerland.
  • Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA.
  • Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
  • Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA.
  • Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
  • Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey.
  • Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA.
  • Department of Neuroradiology, Centre Hospitalier de Toulouse, Toulouse, France.
  • Department of Neuroradiology, Hôpital Universitaire Erasme, Bruxelles, Belgium.
  • Department of Neuroradiology, Ospedale Careggi di Firenze, Florence, Italy.
  • Department of Neurosurgery and Neuroradiology, New York Presbyterian Hospital and Weill Cornell School of Medicine, New York, NY, USA.
  • Department of Neuroradiology, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland.
  • Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
  • Department of Neuroradiology, Hôpital Pitié-Salpêtrière, Paris, France.
  • Department of Neuroradiology, Universitätsklinikum Heidelberg, Heidelberg, Germany.
  • Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Salzburg, Austria.
  • Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA.
  • Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
  • Department of Neuroradiology, Clínica La Sagrada Familia, Buenos Aires, Argentina.
  • Department of Neurosurgery, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA.
  • Department of Neuroradiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia.
  • Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA.
  • Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
  • Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA.
  • Department of Neurosurgery, Yildirim Beyazit University, Ankara, Turkey.
  • Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
  • Department of Neuroradiology, Austin Health, Heidelberg, VIC, Australia.
  • Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA.
  • Department of Neuroradiology, Ospedale Niguarda Cà Granda, Milano, Italy.
  • Department of Neuroradiology, UMass Memorial Hospital, Worcester, MA, USA.
  • Department of Neuroradiology, Ospedale San Raffaele, Milano, Italy.
  • Department of Neurosurgery, University of Miami, Miami, FL, USA.
  • Department of Neuroradiology, Valley Baptist Neuroscience Institute, Harlingen, TX, USA.
  • Departments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland.
  • Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
  • Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.

Abstract

OBJECTIVES

Small Woven EndoBridge (WEB) devices (≤ 4.5 mm) for the intracranial aneurysm treatment are technically challenging to deploy, with limited efficacy and safety data. This study compared functional, angiographic, and safety outcomes of small WEBs with large (> 4.5 mm) and very large (> 7.5 mm) WEBs.

MATERIALS AND METHODS

The WorldWideWEB consortium is a retrospective, multicenter collaboration across 30 international institutions including adults with intracranial aneurysms treated with WEB. Patients were stratified into small (≤ 4.5 mm) and large (> 4.5 mm) groups; a subanalysis compared small with very large (> 7.5 mm) devices. Primary outcome was retreatment rate. Secondary outcomes included modified Rankin Scale (mRS), angiographic outcomes periprocedurally and last follow-up (FU), and safety events (intracranial hemorrhage (ICH) and thromboembolic complications (TECs)).

RESULTS

Among 1473 patients, 229 (15.5%) received small WEBs. Baseline characteristics were similar. Small WEBs showed lower retreatment (4.3% vs 8.8%, p = 0.04) and higher complete occlusion (periprocedurally: 57.1% vs 36.6%, p < 0.01; FU: 76.2% vs 58.5%, p < 0.01). Median mRS was comparable (1 [1-2] vs 1 [1-2], p = 0.88), as was safety (ICH 2.6% vs 0.9%, p = 0.10; TECs 3.1% vs 3.9%, p = 0.69). Very large WEBs had higher retreatment (16.1%, p < 0.001) and lower complete occlusion (periprocedurally: 32.2%, p < 0.001; FU: 50.5%, p < 0.001), with comparable safety (ICH 0.9%, p = 0.27; TECs 4.5%, p = 0.51).

CONCLUSION

Small WEBs demonstrated lower retreatment, superior anatomic and comparable clinical outcomes compared with large devices, with similar safety profiles.

KEY POINTS

Question Do small Woven EndoBridge devices have comparable efficacy and safety to larger devices for intracranial aneurysm treatment despite technical deployment challenges? Findings Small Woven EndoBridge devices (≤ 4.5 mm) achieved lower retreatment rates and superior angiographic occlusion compared with larger devices, with similar safety and functional outcomes. Clinical relevance These findings support the use of small Woven EndoBridge devices for appropriately sized aneurysms, providing reassurance that deployment challenges do not translate into worse clinical outcomes, while superior anatomic outcomes may encourage their broader adoption in clinical practice.

MeSH

Safety, Aneurysm, Radiography, Retreatment, Therapeutics, Intracranial Aneurysm