WEB vs coiling in ruptured aneurysms: A propensity score matched comparison of safety and efficacy

• Published in: Interventional neuroradiology 2023-08, Vol.29 (4), p.402-407
• Main Authors: Nania, Alberto, Gatt, Simon, Banerjee, Rohan, Syed, Maaz BJ, Tiefenbach, Jakov, Dobbs, Nicholas, Du Plessis, Johannes, Keston, Peter, Downer, Johnathan
• Format: Article
• Language: English
• Subjects: Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - etiology; Aneurysm, Ruptured - therapy; Cerebral Angiography; Embolization, Therapeutic - methods; Endovascular Procedures - methods; Follow-Up Studies; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - etiology; Intracranial Aneurysm - therapy; Original s; Propensity Score; Retrospective Studies; Stents; Treatment Outcome
• ISSN: 1591-0199; 2385-2011; 2385-2011
• DOI: 10.1177/15910199221092241

Background We aim to compare the safety and efficacy of WEB with coiling for acutely ruptured aneurysms. METHODS: All consecutive ruptured aneurysms with width suitable for WEB (2–10 mm) treated over 5 years (1/1/2015 to 31/12/2019) were included. We recorded WFNS, Fisher grade, patient demographics and aneurysm characteristics (size, location, D/W and aspect ratio, lobulation). Primary endpoints were mRS status at 3 months, aneurysm occlusion on latest available imaging follow-up, retreatment rate and procedural complications. We applied propensity score matching using aneurysm morphology (size, D/N ratio, ASPECT ratio and lobulation) to optimise matching for WEB versus coil comparison and minimise the effects of confounding. Result A total of 493 patients were identified, 97 treated with the WEB device. 1:1 propensity score matching was used to establish a matched group of 97 patients treated with coiling. The WEB arm showed 3% procedural complication rate, with no haemorrhagic complications and use of adjunctive device in 4%. Satisfactory occlusion on follow-up (mean 14 months) was 79%, with 19% retreatment rate. The coil arm had 8% complication rate, with use of an adjunctive device in 52% of cases (balloon 44%, stent 8%). Satisfactory occlusion on follow-up (mean 22 months) was 90%, with 8% retreatment rate. Conclusion Treatment of ruptured wide-necked bifurcation aneurysms with WEB has a lower complication rate than coiling with high rate of satisfactory occlusion. However, there was a higher retreatment rate when compared with patients treated with coiling. An adjunct device (balloon or stent), was used in over 50% of aneurysms in the coiling group.