gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Comparative analysis of microsurgical clipping and endovascular embolisation with the Woven EndoBridge (WEB) device for the treatment of unruptured anterior circulation aneurysms

Vergleich von Clipping und endovaskulärer Behandlung mit dem Woven EndoBridge (WEB) bei der Behandlung von unrupturierten Aneurysmen im vorderen Hirnkreislauf

Meeting Abstract

  • presenting/speaker Lukas Görtz - Universitätsklinikum Köln, Köln, Deutschland
  • Christoph Kabbasch - Universitätsklinikum Köln, Köln, Deutschland
  • Thomas Liebig - Universitätsklinikum München (LMU), München, Deutschland
  • Eberhard Siebert - Charité Universitätsmedizin, Berlin, Deutschland
  • Franziska Dorn - Universitätsklinikum München (LMU), München, Deutschland
  • Roland Goldbrunner - Universitätsklinikum Köln, Köln, Deutschland
  • Gerrit Brinker - Universitätsklinikum Köln, Köln, Deutschland
  • Boris Krischek - Universitätsklinikum Köln, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV009

doi: 10.3205/21dgnc009, urn:nbn:de:0183-21dgnc0093

Published: June 4, 2021

© 2021 Görtz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: The Woven EndoBridge (WEB) is an intrasaccular device for endovascular treatment of intracranial aneurysms. It consists of a self-expanding, balloon-like mesh of nitinol wires, which is placed within the aneurysm sac and causes immediate flow-disruption through the aneurysm ostium. The WEB allows endovascular treatment of wide-necked bifurcation aneurysms. Hence, there exists an overlap of indications with microsurgical clipping. In the current study, the WEB was retrospectively compared with microsurgical clipping for the treatment of unruptured anterior circulation aneurysms using propensity score adjustment.

Methods: Patients treated with the WEB at three institutions and by microsurgical clipping at one institution between 2011 and 2019 were retrospectively reviewed and included based on the intention-to-treat principle. Aneurysms larger than 11 mm were excluded, since the WEB is not recommended for such aneurysms. Immediate technical treatment success, complications, ischemic stroke, functional outcome and 6-month aneurysm occlusion status were compared. To mitigate a potential selection bias, the inverse probability treatment weighting method was performed based on individual propensity scores.

Results: The final study population consisted of 103 aneurysms (mean size: 6.6±2.2 mm) treated by microsurgical clipping and 63 (mean size: 6.7±2.2) treated with the WEB. The technical success rate was higher in the clipping group (100%) than in the WEB group (83%, adjusted p=0.01). Procedure-related complications occurred more frequently during clipping (13%) than during WEB embolization (6%, adjusted p<0.01). However, the rates of major adverse events were comparable between the clipping group (4%) and the WEB group (3%, adjusted p=0.53). At the 6-month follow-up, a favorable functional outcome (modified Rankin scale ≤ 2) was achieved in 98% of the WEB group and in 99% of the clipping group (adjusted p=0.19). Complete aneurysm occlusion rates were significantly higher in the clipping group (94%) than in the WEB group (75%, adjusted p<0.01).

Conclusion: Microsurgical clipping was associated with higher technical success and complete occlusion rates, while WEB had a lower complication rate. A similar portion of patients achieved favorable functional outcome in both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient’s preferences.