Impact of smoking on recurrence rates among wide-neck intracranial aneurysms treated with Woven EndoBridge: a multicenter retrospective study
Authors: Vaishnav Dhrumil , Essibayi Muhammed Amir , Musmar Basel , Adeeb Nimer , Salim Hamza Adel , Aslan Assala , Cancelliere Nicole M. , McLellan Rachel M. , Algin Oktay , Ghozy Sherief , 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 , Ayberk Giyas , Celal Gunes Yasin , 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 , Diestro Jose Danilo Bengzon , Pukenas Bryan , Burkhardt Jan-Karl , Huynh Thien , Martinez-Gutierrez Juan Carlos , Sheth Sunil A. , Spiegel Gary , Tawk Rabih G. , Lubicz Boris , Panni Pietro , Puri Ajit S. , Pero Guglielmo , Nossek Erez , Raz Eytan , Killer-Oberpfalzer Monika , Griessenauer Christoph J. , Asadi Hamed , Siddiqui Adnan , Brook Allan L. , Haranhalli Neil , 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 , Cuellar-Saenz Hugo H. , Jabbour Pascal M. , Mendes Pereira Vitor , Patel Aman B. , Altschul David J. , Dmytriw Adam A. , _ _ , Dibas Mahmoud , Spears Julian , Sundararajan Sri Hari , Al Balush Ali , Vranic Justin E. , Inoue Yasuaki , Mirshahi Shervin , Alotaibi Naif M. , Harker Pablo , Tutino Vincent M. , Sporns Peter , Brehm Alex 
Published: February 2025

OBJECTIVE
Tobacco smoking is among the factors known to significantly augment the risk of untreated intracranial aneurysm (IA) growth and rupture. Smoking appears to have a variable effect on different endovascular treatment modalities. The impact of smoking on the safety, efficacy, and outcomes of Woven EndoBridge (WEB) device use for wide-neck IAs has not been evaluated. This study aimed to investigate the outcomes of WEB devices by smoking status.

METHODS
A retrospective multicenter analysis was conducted on the data of patients from 36 sites worldwide treated with the WEB device for intracranial saccular aneurysms. Patients were stratified based on smoking status (current, former, and never smokers). The Student t-test and chi-square test were performed for continuous and categorical variables, respectively. Multivariable logistic regression was used to adjust for confounders.

RESULTS
Of 1376 patients with available smoking status, 504 were current smokers, 358 were former smokers, and 514 were never smokers. Upon adjusting for significant confounders, no association was found between smoking and recurrence outcomes (OR 1.39, 95% CI 0.69–2.80; p = 0.36), thromboembolic and hemorrhagic complications, and mortality among IAs treated with the WEB device. There was no statistically significant difference in outcomes between former and never smokers (OR 1.23, 95% CI 0.70–2.18; p = 0.46). The location of aneurysms differed between smoking groups, with former smokers having more anterior circulation aneurysms compared with current and never smokers (99.0% vs 96.9% vs 95.3%; p = 0.01). In terms of clinical symptoms, headache and dizziness were more common in the never smokers compared with current and former smokers (13.9% vs 8.9% vs 7.7%, p = 0.01).

CONCLUSIONS
This large-scale study suggests no significant correlation between smoking and the recurrence of IAs treated with the WEB device. Biological studies are warranted to better understand the biological impact of smoking on the growth and rupture of treated IAs.