Comparison of WEB Embolization and Coiling in Unruptured Intracranial Aneurysms: Safety and Efficacy Based on a Propensity Score Analysis

To compare the safety and efficacy between Woven EndoBridge (WEB) embolization and conventional coiling for treatment of unruptured intracranial aneurysms using a propensity score-matched analysis. Consecutive patients treated with the WEB at 3 German neurovascular centers and with coiling at a single center during 2011 and 2018 were analyzed. Procedure-related complications, clinical outcome, and angiographic results were retrospectively evaluated and compared. Sixty-seven patients treated by coiling and 56 patients treated with the WEB were identified. Significant differences between the 2 groups were observed in patient age (P = 0.048), aneurysm location (P < 0.01), aneurysm size (P = 0.02), and neck width (P < 0.01). The overall complication rate was comparable between the coil group (9.0%) and the WEB group (8.9%, P = 1.0). Favorable outcome (modified Rankin Scale ≤2) was obtained in 98.5% after coiling and 98.2% after WEB treatment. At last available angiographic follow-up, WEB yielded a higher complete aneurysm occlusion rate (87.2%) than coiling (60.8%, P < 0.01). Nine patients in the coil cohort (17.6%) and 2 patients in the WEB cohort (4.3%) underwent retreatment (P = 0.05). After 1:1 propensity score matching, there were no significant differences in complication (P = 1.0) and morbidity rates (P = 1.0), whereas there was a trend toward a higher complete aneurysm occlusion rate after WEB treatment (P = 0.08). Treatment of unruptured aneurysms with the WEB provides potentially higher aneurysm occlusion rates than conventional coiling while having similar complication rates and no additional morbidity.