Comparison of angiographic outcomes of woven endobridge and balloon‐assisted coiling for the treatment of ruptured wide‐necked aneurysms: a multicentric study

Abstract

BACKGROUND: The optimal endovascular approach for acutely ruptured wide-neck intracranial aneurysms remains uncertain, and the use of stent-assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks. Various techniques have been developed to address these challenges, including balloon-assisted coiling (BAC) and intrasaccular flow-disruption. The Woven EndoBridge (WEB) is an intrasaccular device that has shown a favorable efficacy and safety profile for ruptured aneurysms with minimal rebleeding rates. We aimed to compare the clinical and radiological outcomes between WEB and BAC in a cohort of patients with ruptured wide-necked intracranial aneurysms. METHODS: In this international multicenter cohort study, we included consecutive patients treated for ruptured wide-neck intracranial aneurysms with either WEB or BAC at 4 neurovascular centers. The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow-up using the Raymond–Roy scale. Secondary outcomes included a composite of periprocedural hemorrhagic/ischemia-related complications and favorable functional outcome. RESULTS: The study included 104 patients treated with WEB and 107 patients treated with BAC. Of the patients, 60.5% in the WEB group and 53% in the BAC group achieved complete occlusion, with no significant difference between the 2 groups after adjusting for covariates (adjusted odds ratio [OR] = 1.02; 95% CI 0.46–2.25; P = 0.964). The odds of favorable functional outcome did not significantly differ between the WEB (74.8%) and BAC groups (77.4%, adjusted OR = 1.45; 95% CI 0.65– 3.24; P = 0.368). Procedure-related complications were similar in both groups (WEB: 9.6%, BAC: 10.3%, P = 0.872), with no significant difference observed in the rates of ischemic events (WEB: 6.7% versus BAC: 2.8%; P = 0.180) and hemorrhagic events (WEB: 3.8% versus BAC: 7.5%; P = 0.255) between the 2 groups. CONCLUSION: In conclusion, both WEB and BAC techniques showed similar effectiveness and safety outcomes in treating ruptured wide-neck intracranial aneurysms. Further prospective comparative studies are needed to better guide treatment decisions for this patient population.