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Multicenter Study
. 2025 Mar 22;48(1):314.
doi: 10.1007/s10143-025-03439-8.

Prediction of persistent incomplete occlusion of intracranial aneurysms treated with woven EndoBridge device

Muhammed Amir Essibayi  1 , Mohamed Sobhi Jabal  2 , Hasan Jamil  1 , Hamza Adel Salim  3   4 , Basel Musmar  4 , Nimer Adeeb  4 , Mahmoud Dibas  4 , Nicole M Cancelliere  5 , Jose Danilo Bengzon  5 , Oktay Algin  6 , Sherief Ghozy  2 , Sovann V Lay  7 , Adrien Guenego  8 , Leonardo Renieri  9 , Joseph Carnevale  10 , Guillaume Saliou  11 , Panagiotis Mastorakos  12 , Kareem El Naamani  12 , Eimad Shotar  13 , Markus Möhlenbruch  14 , Michael Kral  15 , Charlotte Chung  16 , Mohamed M Salem  17 , Ivan Lylyk  18 , Paul M Foreman  19 , Hamza Shaikh  17 , Vedran Župančić  20 , Muhammad U Hafeez  21 , Joshua Catapano  22 , Muhammad Waqas  23 , Muhammed Said Besler  24 , Yasin Celal Gunes  25 , James D Rabinov  26 , Julian Maingard  27 , Clemens M Schirmer  28 , Mariangela Piano  29 , Anna L Kühn  30 , Caterina Michelozzi  31 , Robert M Starke  32 , Ameer Hassan  33 , Mark Ogilvie  34 , Anh Nguyen  33 , Jesse Jones  34 , Waleed Brinjikji  2 , Marie T Nawka  35 , Marios Psychogios  36 , Christian Ulfert  14 , Bryan Pukenas  17 , Jan-Karl Burkhardt  17 , Thien Huynh  37 , Juan Carlos Martinez-Gutierrez  38 , Sunil A Sheth  38 , Diana Slawski  39 , Rabih Tawk  37 , Benjamin Pulli  39 , Boris Lubicz  8 , Pietro Panni  29 , Ajit S Puri  30 , Guglielmo Pero  29 , Eytan Raz  16 , Christoph J Griessenauer  15 , Hamed Asadi  27 , Adnan Siddiqui  23 , Elad I Levy  23 , Deepak Khatri  1 , Neil Haranhalli  1 , Andrew F Ducruet  22 , Felipe C Albuquerque  22 , Robert W Regenhardt  26 , Christopher J Stapleton  26 , Peter Kan  21 , Vladimir Kalousek  20 , Pedro Lylyk  18 , Srikanth Boddu  10 , Jared Knopman  11 , Stavropoula I Tjoumakaris  12 , Hugo H Cuellar-Saenz  4 , Pascal M Jabbour  12 , Frédéric Clarençon  13 , Nicola Limbucci  10 , Vitor Mendes Pereira  5 , Aman B Patel  26 , David J Altschul  40 , Adam A Dmytriw  5   26 ; WorldWideWEB Consortium Collaborators
Collaborators, Affiliations
Multicenter Study

Prediction of persistent incomplete occlusion of intracranial aneurysms treated with woven EndoBridge device

Muhammed Amir Essibayi et al. Neurosurg Rev. .

Abstract

While the Woven EndoBridge (WEB) device has transformed the treatment of wide-neck intracranial aneurysms, incomplete occlusion remains a significant challenge requiring better understanding of contributing factors. A retrospective analysis was conducted on multicenter data from patients who underwent WEB device treatment for intracranial aneurysms between January 2011 and December 2022. Using machine learning models, Cox regression, and time-stratified analyses, we evaluated factors associated with persistent incomplete occlusion, defined as non-improving Raymond-Roy Occlusion Classification grade 2 or 3 at final follow-up. Among 813 patients (607 with < 24 months follow-up, 206 with ≥ 24 months), machine learning analysis identified aneurysm height, Acom location, neck diameter, and pretreatment mRS as predictors of persistent incomplete occlusion. On Cox regression. larger aneurysm neck diameter (HR 1.13, 95% CI 1.01-1.27, p = 0.027) and height (HR 1.14, 95% CI 1.02-1.26, p = 0.017), and radial access (HR 2.68, 95% CI 1.76-4.07, p < 0.001) increased, while posterior circulation location (HR 0.56, 95% CI 0.37-0.84, p = 0.005) decreased the risk of persistent incomplete occlusion. Time-stratified analysis revealed that in short-term follow-up (< 24 months), larger aneurysm neck diameter (OR 1.28, 95% CI 1.08-1.52, p = 0.004) increased the risk of incomplete occlusion. In long-term follow-up (≥ 24 months), smoking (OR 2.69, 95% CI 1.04-7.00, p = 0.04), higher pre-treatment mRS (OR 1.78, 95% CI 1.15-2.76, p = 0.009), and immediate flow stagnation (OR 0.33, 95% CI 0.11-0.96, p = 0.04) increased, while older age (OR 0.94, 95% CI 0.90-0.98, p = 0.002) and WEB-DL (OR 0.06, p < 0.001) and SLS devices (OR 0.02, p = 0.003) decreased the risk of persistent incomplete occlusion. Aneurysm characteristics and device type significantly influence long-term WEB treatment outcomes.

Keywords: Aneurysms; Brain; Follow-up; Incomplete occlusion; Woven EndoBridge.

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Conflict of interest statement

Declarations. Ethical: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board (IRB) of Albert Einstein College of Medicine (Date 08/11/2023/No 2023-15177). Consent to participate: Patient consent was by the Institutional Review Board (IRB) of Albert Einstein College of Medicine waived given the retrospective design. Competing interests: The authors declare no competing interests. Clinical trial: Clinical trial number: not applicable.

Figures

Fig. 1
Fig. 1
A Receiver operating characteristic curves (B) and evaluation metrics matrix for predicting persistent incomplete occlusion following WEB treatment of cerebral aneurysm
Fig. 2
Fig. 2
Interpretation of the best performing predictive model applied to the test set instances. A SHAP summary plot with the colors signifying feature value and (B) SHAP heatmaps of the 10 most influential features, where the red and blue refer to positive and negative SHAP values
Fig. 3
Fig. 3
SHAP bar plot of feature importance with (A) the mean absolute SHAP value of each feature and (B) the maximal absolute SHAP value of each feature of the test set best-performing model
Fig. 4
Fig. 4
Cox regression analysis forest plot illustrates the predictors of persistent incomplete occlusion over time. *Significant associations were underlined
See this image and copyright information in PMC

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