Widening the Woven EndoBridge: Impact of New Width-Weighted Sizing Method on Woven EndoBridge Selection and Device Compression: A Single Institution Experience in 68 Patients With 12-Month Angiographic Follow-up

BACKGROUND AND OBJECTIVES: The Woven EndoBridge (WEB) device, developed for wide neck bifurcation aneurysms, is sensitive to appropriate sizing. The instructions for use (IFU) sizing method is based on aneurysm width and dome height. In our institution, we developed a method emphasizing width dimensions to guide WEB selection (width weighted method, WWM) to increase device compression at the neck and consequently flow disruption. We sought to explore the impact of the WWM on WEB compression, angiographic flow disruption, and occlusion rates. METHODS: Consecutive patients with cerebral aneurysms with at least 1 year of follow-up (from February 2019 to December 2023), treated with WEB using the standard IFU sizing method vs the WWM method, were included. Clinical, angiographic, and geometric data were collected and analyzed. RESULTS: A total of 68 aneurysms were included (10 ruptured, 58 unruptured). WEB deployment was technically successful in 67 of 68 aneurysms (98.5%), with complications occurring in 2 patients (2.9%). WWM led to increasing device width dimensions in 35 of 68 cases (51%) with low resizing (2/68, 2.8%) rates. Device compression measured based on WWM was higher compared with theoretical compression based on IFU (41% vs 32%, P < .05). Adequate occlusion (web occlusion scale score 0-2) was achieved in 64 of 68 aneurysms (94.1%) at 1-year follow-up. CONCLUSION: WWM is a structured technique that can lead consistent selection of wider devices to better device compression compared with the IFU-based method. This technique may offer safe and superior flow disruption without an increase in complication rate, potentially translating to higher occlusion rates.