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1040 Treatment Strategies for Residual and Recurrent Aneurysms After Woven EndoBridge Therapy a Multicenter Propensity-Matched Analysis
Abstract   Peer reviewed

1040 Treatment Strategies for Residual and Recurrent Aneurysms After Woven EndoBridge Therapy a Multicenter Propensity-Matched Analysis

Vinay Jaikumar, Muhammed Amir Essibayi, Salvador F. Gutierrez-Aguirre, Oded Goren, Ryan C. Ransom, Andres Gudino, Anna Kuhn, Jorge Rios Zermeno, Abdelaziz Amllay, Nicholas Field, …
Neurosurgery, Vol.72(Supplement_1), pp.186-186
04/2026
DOI: 10.1227/neu.0000000000003964_1040

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Abstract

INTRODUCTION: Post-market and multicenter studies report low complete occlusion rates (41-49%) and higher retreatment rates (13%) following WEB deployment, compared to 3.8% with microsurgical clipping. While retreatment after WEB has been shown to be technically feasible, data on final angiographic outcomes remain limited. METHODS: Multivariate regression identified confounding baseline and residual/recurrence presentations, which were balanced using propensity score matching (PSM) for comparison of clinical and angiographic outcomes. RESULTS: Among 211 patients (125 observed, 86 retreated), retreatment was more common in initially ruptured aneurysms (p < 0.001), more among recurrences than residuals (p = 0.036) and sac-dominant residuals/recurrences (p = 0.004). These were primarily due to WEB compression on follow-up (p = 0.001), rather than incomplete occlusion with an appropriately sized device (p < 0.001). Retreatment was associated with significantly higher rates of complete angiographic occlusion at last follow-up compared to observation alone (p < 0.001), a finding that remained consistent across subgroups defined by initial unruptured status, residual/recurrence type (neck vs. aneurysm), and recurrence patterns (all p < 0.05). Clipping demonstrated higher, though statistically insignificant, rates of complete occlusion; flow diversion and stent-assisted coil embolization yielded comparable complete occlusion rates at follow-up. After propensity score matching, retreatment remained significantly associated with higher rates of complete angiographic occlusion (all p < 0.05), with comparable outcomes observed between clipping and endovascular, and between stent-assisted coiling and flow diversion. CONCLUSIONS: Retreatment improved complete occlusion rates; however, no aneurysmal hemorrhages were oberserved in either group. Further intervention may be unnecessary when the WEB device—whether compressed or intact (BOSS 0 or 1)—adequately protects the dome. in cases where WEB compression significantly exposes the aneurysm wall, stent-assisted coiling or flow diversion can be performed safely and successfully, depending on vascular anatomy and surgeon preference.

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