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Influence of operator's learning curve on safety and efficacy of endovascular intracranial aneurysms treatment with Woven EndoBridge

Background & purpose: The Woven EndoBridge (WEB) device is a recent solution for the endovascular treatment of intracranial aneurysms especially wide-neck aneurysms. Despite its innovative aspect and specific deployment technic, the possibility of an associated learning curve has never been explored to date. We aimed to investigate the influence of operator's experience on safety and efficacy of endovascular intracranial aneurysms treatment with WEB.

Material and methods: We conducted a multicenter retrospective study of consecutive patients treated with WEB between March 2014 and June 2020 in two high-volume centers. Patient and aneurysm characteristics, technical, angiographic and clinical outcomes were collected. The influence of operator's experience was measured in number of WEB treatment previously performed.

Results: Among 224 patients (mean age 59.4 +/- 11.5 years) with 237 aneurysms treated with WEB (mean height 6 mm; IQR 4.4-7.7), WEB-related complications occurred in 28 patients (11.8 %) and adequate long-term occlusion was obtained for 154 aneurysms (86%). According to the number of aneurysms previously treated with WEB by operator, the overall complication rate (p=0.442), the WEB-related complication rate (p=0.307), the need of complementary maneuver (p=0.454) and aneurysm occlusion rate were not significantly associated with operator's experience (p=0.264). There was also no significant association between the operator's experience with WEB and the number of WEBs not deployed (0.057 r, p=0.386), procedure duration (-0.024 r, p=0.711) and radiation exposure (0.066 r, p=0.329).

Conclusion: Our study did not demonstrate significant association between operator's experience and safety and efficacy of intracranial aneurysms treatment with WEB device, in high volume neurovascular centers.

Keywords : Intracranial aneurysm, embolization, flowdisrupter, learning curve.