Incidence and predictors of Woven EndoBridge (WEB) shape modification following treatment of intracranial aneurysms in a large multicenter study
Authors: Adeeb Nimer , Salim Hamza Adel , Musmar Basel , Aslan Assala , Swaid Christian , Cuellar Miguel , Dibas Mahmoud , Cancelliere Nicole M. , Diestro Jose Danilo Bengzon , Algin Oktay , Ghozy Sherief , Lay Sovann V. , Guenego Adrien , Renieri Leonardo , Carnevale Joseph , Saliou Guillaume , Mastorakos Panagiotis , Naamani Kareem El , Shotar Eimad , Möhlenbruch Markus , Kral Michael , Chung Charlotte , Salem Mohamed M. , Lylyk Ivan , Foreman Paul M. , Shaikh Hamza , Župančić Vedran , Hafeez Muhammad U. , Catapano Joshua , Waqas Muhammad , Arslan Muhammet , Ergun Onur , Rabinov James D. , Ren Yifan , Schirmer Clemens M. , Piano Mariangela , Kühn Anna L. , Michelozzi Caterina , Starke Robert M. , Hassan Ameer , Ogilvie Mark , Nguyen Anh , Jones Jesse , Brinjikji Waleed , Nawka Marie T. , Psychogios Marios , Ulfert Christian , Pukenas Bryan , Burkhardt Jan-Karl , Huynh Thien , Martinez-Gutierrez Juan Carlos , Essibayi Muhammed Amir , Sheth Sunil A. , Slawski Diana , Tawk Rabih , Pulli Benjamin , Lubicz Boris , Panni Pietro , Puri Ajit S. , Pero Guglielmo , Raz Eytan , Griessenauer Christoph J. , Asadi Hamed , Siddiqui Adnan , Levy Elad I. , Haranhalli Neil , Altschul David , Ducruet Andrew F. , Albuquerque Felipe C. , Regenhardt Robert W. , Stapleton Christopher J. , Kan Peter , Kalousek Vladimir , Lylyk Pedro , Boddu Srikanth , Knopman Jared , Tjoumakaris Stavropoula I. , Jabbour Pascal M. , Clarençon Frédéric , Limbucci Nicola , Yedavalli Vivek , Wintermark Max , Pereira Vitor Mendes , Patel Aman B. , Cuellar-Saenz Hugo H. , Dmytriw Adam A. ,   the Worldwide Web Workgroup
Published: February 2025

Abstract
The Woven EndoBridge (WEB) device is FDA-approved for the treatment of bifurcation aneurysms. Despite its wide popularity, it has been under scrutiny for its association with potential aneurysm recanalization and retreatment due to device shape modification. This study aims to analyze the shape modification rate of WEB devices and identify factors associated with this phenomenon, as well as its correlation with aneurysm retreatment. We conducted a retrospective review of the WorldWide WEB Consortium database, including adult patients treated for intracranial aneurysms with the WEB device. We assessed aneurysm occlusion using the WEB Occlusion Scale and defined WEB shape modification as a percentage reduction in the distance between two WEB markers. Logistic regression and Cox proportional hazards models were utilized to evaluate predictors of shape modification and retreatment. Kaplan–Meier curves were used to estimate the time-dependent probability of no or minor shape modification. A total of 405 patients were analyzed, with minor and major shape modification occurring in 31.4% and 10.1% of cases, respectively. Major shape modification was associated with lower rates of adequate occlusion (70.7%) compared to no or minor shape modification (86.6%) and a higher rate of retreatment (26.8% vs. 8.1%). Predictors of major shape modification included the presence of daughter sac, bifurcation aneurysms, absence of immediate flow stagnation, and a WEB width minus aneurysm width ratio ≤ 0.5. The probability of no or minor shape modification declined within the first 25 months and stabilized thereafter. WEB device shape modification is a significant predictor of aneurysm occlusion efficacy and retreatment. Recognizing the factors influencing shape modification can guide treatment decisions and follow-up protocols to improve patient outcomes.