Thromboembolic Events Detected by Diffusion-Weighted MRI after Woven EndoBridge Device Treatment: Diameter Ratio...

Periprocedural thromboembolic events are common complications of neuroendovascular treatment. We aimed to determine the incidence and potential risk factors of DWI-positive lesions detected on postoperative MRI after Woven EndoBridge (WEB) treatment for intracranial aneurysms.

Between February 2021 and April 2025, 55 patients underwent WEB treatment for 59 intracranial aneurysms at 2 neurovascular institutions in Japan. Of these, 37 patients with 40 unruptured intracranial aneurysms treated with the WEB device alone were retrospectively enrolled. The distal access catheter/parent artery ratio was defined as the outer diameter of the distal tip of the distal access catheter divided by the diameter of the parent artery. MRI was performed within 48 hours after the procedure to evaluate appearance and number of DWI-positive lesions.

DWI-positive lesions after WEB treatment were confirmed in 28 (70.0%) unruptured intracranial aneurysms. Univariate analysis revealed a trend toward a higher proportion of age ≥70 years (DWI-positive lesion [-] group: 33.3% vs [+] group: 64.3%, P = .09). The proportion of distal access catheter/parent artery ratio ≥0.70 differed significantly between the 2 groups (DWI-positive lesion [-] group: 8.3% vs [+] group: 53.6%, P = .01). In the multiple logistic regression model using age and distal access catheter/parent artery ratio, a distal access catheter/parent artery ratio (OR, 111.00; 95% CI, 0.76-16,000.00; P = .06) was identified as a marginally significant risk factor for postprocedural DWI-positive lesions. Furthermore, the eligible cases were divided into 2 groups: DWI-positive lesion ≥10 (-) group (n=31, 77.5%) and ≥10 (+) group (n=9, 22.5%). Univariate analysis revealed significant differences in the proportion of age ≥70 years (45.2% vs 88.9%; P = .03) and those with a distal access catheter/parent artery ratio ≥0.80 (9.7% vs 66.7%; P = .001). In the multiple logistic regression model using age and distal access catheter/parent artery ratio, a significant relationship was found between distal access catheter/parent artery ratio (OR, 1400.00; 95% CI, 3.70-533,000.00; P = .02) and postprocedural DWI-positive lesion ≥10 after WEB treatment.

Distal access catheter/parent artery ratio in WEB treatment may affect DWI-positive lesion incidence and postprocedural count.