Comparison of WEB Embolization and Coiling in Unruptured Intracranial Aneurysms: Safety and Efficacy Based on a Propensity Score Analysis

World Neurosurg. 2019 Jun:126:e937-e943. doi: 10.1016/j.wneu.2019.03.016. Epub 2019 Mar 9.


Objective: To compare the safety and efficacy between Woven EndoBridge (WEB) embolization and conventional coiling for treatment of unruptured intracranial aneurysms using a propensity score-matched analysis.

Methods: Consecutive patients treated with the WEB at 3 German neurovascular centers and with coiling at a single center during 2011 and 2018 were analyzed. Procedure-related complications, clinical outcome, and angiographic results were retrospectively evaluated and compared.

Results: Sixty-seven patients treated by coiling and 56 patients treated with the WEB were identified. Significant differences between the 2 groups were observed in patient age (P = 0.048), aneurysm location (P < 0.01), aneurysm size (P = 0.02), and neck width (P < 0.01). The overall complication rate was comparable between the coil group (9.0%) and the WEB group (8.9%, P = 1.0). Favorable outcome (modified Rankin Scale ≤2) was obtained in 98.5% after coiling and 98.2% after WEB treatment. At last available angiographic follow-up, WEB yielded a higher complete aneurysm occlusion rate (87.2%) than coiling (60.8%, P < 0.01). Nine patients in the coil cohort (17.6%) and 2 patients in the WEB cohort (4.3%) underwent retreatment (P = 0.05). After 1:1 propensity score matching, there were no significant differences in complication (P = 1.0) and morbidity rates (P = 1.0), whereas there was a trend toward a higher complete aneurysm occlusion rate after WEB treatment (P = 0.08).

Conclusions: Treatment of unruptured aneurysms with the WEB provides potentially higher aneurysm occlusion rates than conventional coiling while having similar complication rates and no additional morbidity.

Keywords: Coiling; Propensity score; Unruptured intracranial aneurysm; WEB; Woven EndoBridge.

MeSH terms

  • Adult
  • Aged
  • Cerebral Angiography
  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / methods*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Propensity Score
  • Retrospective Studies
  • Stents
  • Treatment Outcome