Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms—A retrospective analysis of the WorldWide WEB Consortium database
Authors: Musmar Basel , Adeeb Nimer , Gendreau Julian , Horowitz Melanie Alfonzo , Salim Hamza Adel , Sanmugananthan Praveen , Aslan Assala , Brown Nolan J , Cancelliere Nicole M , McLellan Rachel M , Algin Oktay , Ghozy Sherief , Dibas Mahmoud , Orscelik Atakan , Senol Yigit Can , Lay Sovann V , Guenego Adrien , Renieri Leonardo , Carnevale Joseph , Saliou Guillaume , Mastorakos Panagiotis , El Naamani Kareem , Shotar Eimad , Premat Kevin , Möhlenbruch Markus , Kral Michael , Doron Omer , Chung Charlotte , Salem Mohamed M , Lylyk Ivan , Foreman Paul M , Vachhani Jay A , Shaikh Hamza , Župančić Vedran , Hafeez Muhammad U , Catapano Joshua , Waqas Muhammad , Tutino Vincent M , Gokhan Yuce , Imamoglu Cetin , Bayrak Ahmet , Rabinov James D , Ren Yifan , Schirmer Clemens M , Piano Mariangela , Kühn Anna L , Michelozzi Caterina , Elens Stéphanie , Starke Robert M , Hassan Ameer E , Ogilvie Mark , Nguyen Anh , Jones Jesse , Brinjikji Waleed , Nawka Marie T , Psychogios Marios , Ulfert Christian , Bengzon Diestro Jose Danilo , Pukenas Bryan , Burkhardt Jan-Karl , Huynh Thien , 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-Oberfalzer Monika , Griessenauer Christoph J , Asadi Hamed , Siddiqui Adnan , 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 , Knopman Jared , Aziz-Sultan Mohammad A , Tjoumakaris Stavropoula I , Clarençon Frédéric , Limbucci Nicola , Bydon Mohamad , Hasan David , Cuellar-Saenz Hugo H , Jabbour Pascal M , Pereira Vitor Mendes , Patel Aman B , Dmytriw Adam A 
Published: August 2024

Background

Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond–Roy classification 1 or 2) remains challenging.

Objective

Our study sought to develop and validate a predictive calculator for adequate occlusion using the WEB device via data from a large multi-institutional retrospective cohort.

Methods

We used data from the WorldWide WEB Consortium, encompassing 356 patients from 30 centers across North America, South America, and Europe. Bivariate and multivariate regression analyses were performed on a variety of demographic and clinical factors, from which predictive factors were selected. Calibration and validation were conducted, with variance inflation factor (VIF) parameters checked for collinearity.

Results

A total of 356 patients were included: 124 (34.8%) were male, 108 (30.3%) were elderly (≥65 years), and 118 (33.1%) were current smokers. Mean maximum aneurysm diameter was 7.09 mm (SD 2.71), with 112 (31.5%) having a daughter sac. In the multivariate regression, increasing aneurysm neck size (OR 0.706 [95% CI: 0.535–0.929], p = 0.13) and partial aneurysm thrombosis (OR 0.135 [95% CI: 0.024–0.681], p = 0.016) were found to be the only statistically significant variables associated with poorer likelihood of achieving occlusion. The predictive calculator shows a c-statistic of 0.744. Hosmer–Lemeshow goodness-of-fit test indicated a satisfactory model fit with a p-value of 0.431. The calculator is available at: https://neurodx.shinyapps.io/WEBDEVICE/ .

Conclusion

The predictive calculator offers a substantial contribution to the clinical toolkit for estimating the likelihood of adequate intracranial aneurysm occlusion by WEB device embolization.