Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study
Authors: Diestro Jose Danilo Bengzon , Dibas Mahmoud , Adeeb Nimer , Regenhardt Robert W. , Vranic Justin E. , Guenego Adrien , Lay Sovann V. , Renieri Leonardo , Balushi Ali Al , Shotar Eimad , Premat Kévin , Namaani Kareem El , Saliou Guillaume , Möhlenbruch Markus A. , Lylyk Ivan , Foreman Paul M. , Vachhani Jay A. , Župančić Vedran , Hafeez Muhammad U. , Rutledge Caleb , Rai Hamid , Tutino Vincent M. , Mirshahi Shervin , Ghozy Sherief , Harker Pablo , Alotaibi Naif M. , Rabinov James D. , Ren Yifan , Schirmer Clemens M. , Goren Oded , Piano Mariangela , Kühn Anna L. , Michelozzi Caterina , Elens Stéphanie , Starke Robert M. , Hassan Ameer E. , Salehani Arsalaan , Nguyen Anh , Jones Jesse , Psychogios Marios , Spears Julian , Marotta Thomas , Pereira Vitor , Parra-Fariñas Carmen , Bres-Bullrich Maria , Mayich Michael , Salem Mohamed M. , Burkhardt Jan-Karl , Jankowitz Brian T. , Domingo Ricardo A. , Huynh Thien , Tawk Rabih , Ulfert Christian , Lubicz Boris , Panni Pietro , Puri Ajit S. , Pero Guglielmo , Griessenauer Christoph J. , Asadi Hamed , Siddiqui Adnan , Ducruet Andrew F. , Albuquerque Felipe C. , Patel Nirav , Kan Peter , Kalousek Vladimir , Lylyk Pedro , Boddu Srikanth , Stapleton Christopher J. , Knopman Jared , Jabbour Pascal , Tjoumakaris Stavropoula , Clarençon Frédéric , Limbucci Nicola , Aziz-Sultan Mohammad A. , Cuellar-Saenz Hugo H. , Cognard Christophe , Patel Aman B. , Dmytriw Adam A. 
Published: October 2023

OBJECTIVE
The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device.

METHODS
The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use.

RESULTS
The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use.

CONCLUSIONS
This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.