Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database

Basel Musmar¹, Nimer Adeeb¹, Julian Gendreau¹, Melanie Alfonzo Horowitz¹, Hamza Adel Salim¹, Praveen Sanmugananthan¹, Assala Aslan¹, Nolan J Brown¹, Nicole M Cancelliere², Rachel M McLellan³, Oktay Algin⁴, Sherief Ghozy⁵, Mahmoud Dibas¹, Atakan Orscelik⁵, Yigit Can Senol⁵, Sovann V Lay⁶, Adrien Guenego⁷, Leonardo Renieri⁸, Joseph Carnevale⁹, Guillaume Saliou¹⁰, Panagiotis Mastorakos¹¹, Kareem El Naamani¹¹, Eimad Shotar¹², Kevin Premat¹², Markus Möhlenbruch¹³, Michael Kral¹⁴, Omer Doron³, Charlotte Chung¹⁵, Mohamed M Salem¹⁶, Ivan Lylyk¹⁷, Paul M Foreman¹⁸, Jay A Vachhani¹⁸, Hamza Shaikh¹⁹, Vedran Župančić²⁰, Muhammad U Hafeez²¹, Joshua Catapano²², Muhammad Waqas²³, Vincent M Tutino²³, Yuce Gokhan⁴, Cetin Imamoglu⁴, Ahmet Bayrak⁴, James D Rabinov³, Yifan Ren²⁴, Clemens M Schirmer²⁵, Mariangela Piano²⁶, Anna L Kühn²⁷, Caterina Michelozzi²⁸, Stéphanie Elens⁸, Robert M Starke²⁹, Ameer E Hassan³⁰, Mark Ogilvie³¹, Anh Nguyen³², Jesse Jones³¹, Waleed Brinjikji⁵, Marie T Nawka³³, Marios Psychogios³², Christian Ulfert¹³, Jose Danilo Bengzon Diestro², Bryan Pukenas¹⁶, Jan-Karl Burkhardt¹⁶, Thien Huynh³⁴, Juan Carlos Martinez-Gutierrez³⁵, Muhammed Amir Essibayi³⁶, Sunil A Sheth³⁵, Gary Spiegel³⁵, Rabih Tawk³⁴, Boris Lubicz⁸, Pietro Panni²⁸, Ajit S Puri²⁷, Guglielmo Pero²⁶, Erez Nossek¹⁵, Eytan Raz¹⁵, Monika Killer-Oberfalzer¹⁴, Christoph J Griessenauer¹⁴, Hamed Asadi¹⁵, Adnan Siddiqui²³, Allan L Brook³⁶, David Altschul³⁶, Andrew F Ducruet²², Felipe C Albuquerque²², Robert W Regenhardt³, Christopher J Stapleton³, Peter Kan²¹, Vladimir Kalousek²⁰, Pedro Lylyk¹⁷, Srikanth Boddu¹⁰, Jared Knopman¹⁰, Mohammad A Aziz-Sultan⁴, Stavropoula I Tjoumakaris¹¹, Frédéric Clarençon¹², Nicola Limbucci⁹, Mohamad Bydon⁵, David Hasan³⁷, Hugo H Cuellar-Saenz¹, Pascal M Jabbour¹¹, Vitor Mendes Pereira³, Aman B Patel³, Adam A Dmytriw³

Affiliations

¹ Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA.
² Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
⁴ Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey.
⁵ Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA.
⁶ Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France.
⁷ Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles Belgique, Belgium.
⁸ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
⁹ Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA.
¹⁰ Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland.
¹¹ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
¹² Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France.
¹³ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
¹⁴ Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
¹⁵ Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA.
¹⁶ Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA.
¹⁷ Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina.
¹⁸ Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA.
¹⁹ Departments of Radiology & Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.
²⁰ Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia.
²¹ Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA.
²² Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
²³ Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA.
²⁴ Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia.
²⁵ Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA.
²⁶ Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy.
²⁷ Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA.
²⁸ Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy.
²⁹ Deparment of Neurosurgery, University of Miami, Miami, FL, USA.
³⁰ Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA.
³¹ Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Tuscaloosa, AL, USA.
³² Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland.
³³ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³⁴ Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
³⁵ Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
³⁶ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
³⁷ Department of Neurosurgery, Duke University Hospital, Durham, NC, USA.

PMID: 39127463
PMCID: PMC11571495
DOI: 10.1177/15910199241267320

Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database

Basel Musmar et al. Interv Neuroradiol. 2024.

. 2024 Aug 10:15910199241267320.

doi: 10.1177/15910199241267320. Online ahead of print.

Authors

Affiliations

¹ Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA.
² Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
⁴ Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey.
⁵ Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA.
⁶ Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France.
⁷ Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles Belgique, Belgium.
⁸ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
⁹ Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA.
¹⁰ Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland.
¹¹ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
¹² Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France.
¹³ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
¹⁴ Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
¹⁵ Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA.
¹⁶ Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA.
¹⁷ Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina.
¹⁸ Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA.
¹⁹ Departments of Radiology & Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.
²⁰ Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia.
²¹ Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA.
²² Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
²³ Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA.
²⁴ Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia.
²⁵ Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA.
²⁶ Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy.
²⁷ Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA.
²⁸ Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy.
²⁹ Deparment of Neurosurgery, University of Miami, Miami, FL, USA.
³⁰ Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA.
³¹ Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Tuscaloosa, AL, USA.
³² Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland.
³³ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³⁴ Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
³⁵ Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
³⁶ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
³⁷ Department of Neurosurgery, Duke University Hospital, Durham, NC, USA.

PMID: 39127463
PMCID: PMC11571495
DOI: 10.1177/15910199241267320

Abstract

Background: Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond-Roy classification 1 or 2) remains challenging.

Objective: Our study sought to develop and validate a predictive calculator for adequate occlusion using the WEB device via data from a large multi-institutional retrospective cohort.

Methods: We used data from the WorldWide WEB Consortium, encompassing 356 patients from 30 centers across North America, South America, and Europe. Bivariate and multivariate regression analyses were performed on a variety of demographic and clinical factors, from which predictive factors were selected. Calibration and validation were conducted, with variance inflation factor (VIF) parameters checked for collinearity.

Results: A total of 356 patients were included: 124 (34.8%) were male, 108 (30.3%) were elderly (≥65 years), and 118 (33.1%) were current smokers. Mean maximum aneurysm diameter was 7.09 mm (SD 2.71), with 112 (31.5%) having a daughter sac. In the multivariate regression, increasing aneurysm neck size (OR 0.706 [95% CI: 0.535-0.929], p = 0.13) and partial aneurysm thrombosis (OR 0.135 [95% CI: 0.024-0.681], p = 0.016) were found to be the only statistically significant variables associated with poorer likelihood of achieving occlusion. The predictive calculator shows a c-statistic of 0.744. Hosmer-Lemeshow goodness-of-fit test indicated a satisfactory model fit with a p-value of 0.431. The calculator is available at: https://neurodx.shinyapps.io/WEBDEVICE/.

Conclusion: The predictive calculator offers a substantial contribution to the clinical toolkit for estimating the likelihood of adequate intracranial aneurysm occlusion by WEB device embolization.

Keywords: Aneurysm; WEB device; cerebrovascular; prediction.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

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Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database

Affiliations

Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources