Persistent flow inside the Woven EndoBridge at angiographic follow-up: A multicenter study

Area of Science:

• Endovascular neurosurgery
• Cerebrovascular diseases
• Medical devices

Background:

• Persistent intra-device filling (BOSS 1) after Woven Endobridge (WEB) device treatment for aneurysms is infrequent.
• Previous studies on BOSS 1 cases are limited to monocentric case series.
• This multicenter study investigates the incidence and risk factors of intra-WEB persistent filling.

Purpose of the Study:

• To determine the incidence of persistent intra-device filling (BOSS 1) in aneurysms treated with WEB devices.
• To identify risk factors associated with intra-WEB persistent filling.
• To compare baseline characteristics, treatment modalities, and aneurysm data between BOSS 1 and non-BOSS 1 patients.

Main Methods:

• Retrospective multicenter study involving European academic centers.
• Collected de-identified data from patients treated with WEB devices and undergoing angiographic follow-up at least 3 months post-embolization.
• Compared BOSS 1 patients with a control group of non-BOSS 1 patients (n=116) using univariable and multivariable analyses.

Main Results:

• The incidence of persistent flow (BOSS 1) was 5.2% (31/591 aneurysms) at an average follow-up of 8.7 months.
• Multivariable analysis identified postoperative dual antiplatelet therapy (aOR 4.3) and WEB undersizing (aOR 10.8) as independent risk factors for BOSS 1.
• These factors were significantly associated with persistent flow within the WEB device.

Conclusions:

• Persistent blood flow within the WEB device (BOSS 1) is an uncommon complication.
• Post-procedural dual antiplatelet therapy and undersizing of the WEB device are independently associated with the occurrence of BOSS 1.
• These findings highlight potential modifiable risk factors for improving WEB device outcomes.