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Multicenter Study
. 2024 Oct 11;142(3):647-657.
doi: 10.3171/2024.5.JNS232204. Print 2025 Mar 1.

Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization

Nimer Adeeb  1 , Basel Musmar  1 , Hamza Adel Salim  1 , Assala Aslan  1 , Anika Alla  1 , Nicole M Cancelliere  2 , Rachel M McLellan  3 , Oktay Algin  4 , Sherief Ghozy  5 , Mahmoud Dibas  1 , Sovann V Lay  6 , Adrien Guenego  7 , Leonardo Renieri  8 , Joseph Carnevale  9 , Guillaume Saliou  10 , Panagiotis Mastorakos  11 , Kareem El Naamani  11 , Eimad Shotar  12 , Kevin Premat  12 , Markus Möhlenbruch  13 , Michael Kral  14 , Omer Doron  3 , Charlotte Chung  15 , Mohamed M Salem  16 , Ivan Lylyk  17 , Paul M Foreman  18 , Jay A Vachhani  18 , Hamza Shaikh  19 , Vedran Župančić  20 , Muhammad U Hafeez  21 , Joshua S Catapano  22 , Muhammad Waqas  23 , Vincent M Tutino  23 , Mohamed K Ibrahim  5 , Marwa A Mohammed  5 , M Ozgur Ozates  4 , Giyas Ayberk  4 , James D Rabinov  3 , Yifan Ren  24 , Clemens M Schirmer  25 , Mariangela Piano  26 , Anna L Kühn  27 , Caterina Michelozzi  28 , Stéphanie Elens  8 , Robert M Starke  29 , Ameer Hassan  30 , Mark Ogilvie  31 , Anh Nguyen  32 , Jesse Jones  31 , Waleed Brinjikji  5 , Marie T Nawka  33 , Marios Psychogios  32 , Christian Ulfert  13 , Jose Danilo Bengzon Diestro  2 , Bryan Pukenas  16 , Jan-Karl Burkhardt  16 , Ricardo A Domingo  34 , Thien Huynh  34 , Juan Carlos Martinez-Gutierrez  35 , Muhammed Amir Essibayi  36 , Sunil A Sheth  35 , Gary Spiegel  35 , Rabih G Tawk  34 , Boris Lubicz  8 , Pietro Panni  28 , Ajit S Puri  27 , Guglielmo Pero  26 , Erez Nossek  15 , Eytan Raz  15 , Monika Killer-Oberfalzer  14 , Christoph J Griessenauer  14 , Hamed Asadi  15 , Adnan Siddiqui  23 , Allan L Brook  36 , David Altschul  36 , Andrew F Ducruet  22 , Felipe C Albuquerque  22 , Robert W Regenhardt  3 , Christopher J Stapleton  3 , Peter Kan  21 , Vladimir Kalousek  20 , Pedro Lylyk  17 , Srikanth Boddu  10 , Jared Knopman  10 , Mohammad A Aziz-Sultan  4 , Stavropoula I Tjoumakaris  11 , Frédéric Clarençon  12 , Nicola Limbucci  9 , Hugo H Cuellar-Saenz  1 , Pascal M Jabbour  11 , Vitor Mendes Pereira  3 , Aman B Patel  3 , Adam A Dmytriw  3
Affiliations
Multicenter Study

Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization

Nimer Adeeb et al. J Neurosurg. .

Abstract

Objective: The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors' objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment.

Methods: The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size.

Results: The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters.

Conclusions: This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.

Keywords: WEB; Woven EndoBridge; aneurysms; intracranial; vascular disorders.

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