The impact of postoperative aspirin in patients undergoing Woven EndoBridge: a multicenter, institutional, propensity score-matched analysis
Authors: Dmytriw Adam A , Musmar Basel , Salim Hamza , Aslan Assala , Cancelliere Nicole M , McLellan Rachel M , Algin Oktay , Ghozy Sherief , Dibas Mahmoud , Lay Sovann V , Guenego Adrien , Renieri Leonardo , Carnevale Joseph Anthony , Saliou Guillaume , Mastorakos Panagiotis , El Naamani Kareem , Shotar Eimad , Premat Kevin , Möhlenbruch Markus A , Kral Michael , Doron Omer , Chung Charlotte , Salem Mohamed M , Lylyk Ivan , Foreman Paul M , Vachhani Jay A , Shaikh Hamza , Župančić Vedran , Hafeez Muhammad Ubaid , Catapano Joshua S , Waqas Muhammad , Tutino Vincent M , Ibrahim Mohamed K , Mohammed Marwa A , Imamoglu Cetin , Bayrak Ahmet , Rabinov James D , Ren Yifan , Schirmer Clemens M , Piano Mariangela , Kuhn Anna Luisa , Michelozzi Caterina , Elens Stephanie , Hasan Zuha , Starke Robert M , Hassan Ameer E , Ogilvie Mark , Nguyen Anh , Jones Jesse , Brinjikji Waleed , Nawka Marie Teresa , Psychogios Marios-Nikos , Ulfert Christian , Diestro Jose Danilo Bengzon , Pukenas Bryan , Burkhardt Jan Karl , Huynh Thien J , Martinez-Gutierrez Juan Carlos , Essibayi Muhammed Amir , Sheth Sunil A , Spiegel Gary , Tawk Rabih , Lubicz Boris , Panni Pietro , Puri Ajit S , Pero Guglielmo , Nossek Erez , Raz Eytan , Killer-Oberpfalzer Monika , Griessenauer Christoph J , Asadi Hamed , Siddiqui Adnan H , Brook Allan L , Altschul David , Ducruet Andrew F , Albuquerque Felipe C , Regenhardt Robert W , Stapleton Christopher J , Kan Peter , Kalousek Vladimir , Lylyk Pedro , Boddu Srikanth Reddy , Knopman Jared , Aziz-Sultan Mohammad A , Tjoumakaris Stavropoula I , Clarençon Frédéric , Limbucci Nicola , Cuellar Hugo H , Jabbour Pascal M , Pereira Vitor M , Patel Aman B , Adeeb Nimer 
Published: January 2024

Background

The Woven EndoBridge (WEB) device is frequently used for the treatment of intracranial aneurysms. Postoperative management, including the use of aspirin, varies among clinicians and institutions, but its impact on the outcomes of the WEB has not been thoroughly investigated.

Methods

This was a retrospective, multicenter study involving 30 academic institutions in North America, South America, and Europe. Data from 1492 patients treated with the WEB device were included. Patients were categorized into two groups based on their postoperative use of aspirin (aspirin group: n=1124, non-aspirin group: n=368). Data points included patient demographics, aneurysm characteristics, procedural details, complications, and angiographic and functional outcomes. Propensity score matching (PSM) was applied to balance variables between the two groups.

Results

Prior to PSM, the aspirin group exhibited significantly higher rates of modified Rankin scale (mRS) mRS 0–1 and mRS 0–2 (89.8% vs 73.4% and 94.1% vs 79.8%, p<0.001), lower rates of mortality (1.6% vs 8.6%, p<0.001), and higher major compaction rates (13.4% vs 7%, p<0.001). Post-PSM, the aspirin group showed significantly higher rates of retreatment (p=0.026) and major compaction (p=0.037) while maintaining its higher rates of good functional outcomes and lower mortality rates. In the multivariable regression, aspirin was associated with higher rates of mRS 0–1 (OR 2.166; 95% CI 1.16 to 4, p=0.016) and mRS 0–2 (OR 2.817; 95% CI 1.36 to 5.88, p=0.005) and lower rates of mortality (OR 0.228; 95% CI 0.06 to 0.83, p=0.025). However, it was associated with higher rates of retreatment (OR 2.471; 95% CI 1.11 to 5.51, p=0.027).

Conclusions

Aspirin use post-WEB treatment may lead to better functional outcomes and lower mortality but with higher retreatment rates. These insights are crucial for postoperative management after WEB procedures, but further studies are necessary for validation.