The goal of this project is to better characterize the optimal device to aneurysm volume ratio to predict successful WEB device implantation.      

The Woven EndoBridge (WEB) has recently been approved by FDA for the treatment of saccular, wide-neck bifurcation intracranial aneurysms.  Unlike stent-assisted coiling, the WEB device does not require dual anti-platelet therapy, which decreases risk of hemorrhagic complications. However, in aneurysms with irregular morphology, choosing the appropriate device size may be challenging. 

Retrospective study of WEB device patients was conducted between 2/15/19–5/6/2020. Aneurysm volume was calculated with 3D DSA reconstruction imaging using proprietary software (SIEMENS, Germany). Success was defined if the device fits completely into aneurysm. Failure was considered if the device protrudes out or if coil or stent was used in conjunction, or if the operator changes the device based on inaccurate measurement/sizing of the aneurysm and WEB device. Radiographic outcome was measured using the WEB-IT classification: Grade A (no contrast in sac or neck), Grade B (no contrast in sac some contrast in neck), and Grade C (contrast in sac) at follow up.

45 patients with 47 aneurysms were included. Successful group included 32 aneurysms (68%) while the failure group had 15 aneurysms (32%). There were no significant differences between successful and failure groups in Grade A (33% vs. 38%, p=1), Grade B (46% vs. 25%, p=0.420), or Grade C (21% vs. 38%, p=0.378), at their clinical follow-ups respectively. A total of 24 aneurysms were also analyzed for their 3D volume. There was no significant difference in the median device-aneurysm volume ratio between the successful (0.65; IQR 0.56-0.83) and failure (0.96; IQR 0.47-1.17) implantation groups (p=0.438).

We did not observe any statistical differences among the successful and failure groups. However, the successful implantation of the device was highest between 0.56-0.83 device-aneurysm volume ratio.