Woven Endobridge device for ruptured vs. unruptured aneurysms: insights from the WorldWideWEB study

Purpose: Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. Methods: We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). Results: Among 1,220 patients, 342 (28.0%) presented with ruptured aneurysms. Propensity-score-matched analyses revealed no significant difference in thromboembolic complications (11.8% vs. 5.9%, p = 0.056), similar periprocedural adequate occlusion (53.3% vs. 53.8%, p > 0.9), and similar retreatment rates (11.8% (95% CI 7.8–17.6%) vs. 7.1% (95% CI 4.1–12.0%), p = 0.14); however, adequate occlusion at follow-up was lower (82.2% vs. 93.3%, p = 0.002) and functional outcomes were worse (mRS ≥ 2 in 34.1% vs. 21.9%, p = 0.012) among patients with ruptured aneurysms. Conclusion: Ruptured aneurysms demonstrated expected inferior follow-up functional and angiographic outcomes when compared with unruptured aneurysms, but no difference in retreatment rate and procedural safety. These findings support WEB as a safe and effective treatment option for appropriately selected ruptured intracranial aneurysms in routine clinical practice.