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

Author:

Musmar Basel1ORCID,Adeeb Nimer1,Gendreau Julian1,Horowitz Melanie Alfonzo1ORCID,Salim Hamza Adel1ORCID,Sanmugananthan Praveen1,Aslan Assala1,Brown Nolan J1,Cancelliere Nicole M2,McLellan Rachel M3,Algin Oktay4ORCID,Ghozy Sherief5ORCID,Dibas Mahmoud1ORCID,Orscelik Atakan5,Senol Yigit Can5ORCID,Lay Sovann V6,Guenego Adrien7ORCID,Renieri Leonardo8,Carnevale Joseph9,Saliou Guillaume10,Mastorakos Panagiotis11,El Naamani Kareem11ORCID,Shotar Eimad12ORCID,Premat Kevin12,Möhlenbruch Markus13,Kral Michael14,Doron Omer3,Chung Charlotte15,Salem Mohamed M16,Lylyk Ivan17ORCID,Foreman Paul M18ORCID,Vachhani Jay A18,Shaikh Hamza19ORCID,Župančić Vedran20ORCID,Hafeez Muhammad U21ORCID,Catapano Joshua22,Waqas Muhammad23,Tutino Vincent M23,Gokhan Yuce4,Imamoglu Cetin4,Bayrak Ahmet4,Rabinov James D3,Ren Yifan24ORCID,Schirmer Clemens M25ORCID,Piano Mariangela26,Kühn Anna L27,Michelozzi Caterina28,Elens Stéphanie8,Starke Robert M29,Hassan Ameer E30ORCID,Ogilvie Mark31,Nguyen Anh32ORCID,Jones Jesse31ORCID,Brinjikji Waleed5,Nawka Marie T33,Psychogios Marios32,Ulfert Christian13ORCID,Bengzon Diestro Jose Danilo2,Pukenas Bryan16,Burkhardt Jan-Karl16,Huynh Thien34,Martinez-Gutierrez Juan Carlos35,Essibayi Muhammed Amir36ORCID,Sheth Sunil A35,Spiegel Gary35,Tawk Rabih34,Lubicz Boris8,Panni Pietro28,Puri Ajit S27,Pero Guglielmo26ORCID,Nossek Erez15,Raz Eytan15ORCID,Killer-Oberfalzer Monika14,Griessenauer Christoph J14ORCID,Asadi Hamed15,Siddiqui Adnan23ORCID,Brook Allan L36,Altschul David36ORCID,Ducruet Andrew F22,Albuquerque Felipe C22,Regenhardt Robert W3ORCID,Stapleton Christopher J3,Kan Peter21,Kalousek Vladimir20,Lylyk Pedro17,Boddu Srikanth10,Knopman Jared10,Aziz-Sultan Mohammad A4,Tjoumakaris Stavropoula I11,Clarençon Frédéric12,Limbucci Nicola9ORCID,Bydon Mohamad5,Hasan David37,Cuellar-Saenz Hugo H1ORCID,Jabbour Pascal M11,Pereira Vitor Mendes3,Patel Aman B3,Dmytriw Adam A3ORCID

Affiliation:

1. Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA

2. Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada

3. Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA

4. Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey

5. Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA

6. Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France

7. Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles Belgique, Belgium

8. Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy

9. Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA

10. Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland

11. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

12. Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France

13. Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany

14. Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria

15. Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA

16. Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA

17. Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina

18. Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA

19. Departments of Radiology & Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA

20. Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center ‘Sisters of Mercy’, Zagreb, Croatia

21. Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA

22. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

23. Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA

24. Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia

25. Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA

26. Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy

27. Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA

28. Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy

29. Deparment of Neurosurgery, University of Miami, Miami, FL, USA

30. Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA

31. Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Tuscaloosa, AL, USA

32. Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland

33. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

34. Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

35. Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA

36. Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

37. Department of Neurosurgery, Duke University Hospital, Durham, NC, USA

Abstract

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.

Publisher

SAGE Publications

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