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Clin Neurol Neurosurg. 2018 Mar;166:110-115. doi: 10.1016/j.clineuro.2018.01.025. Epub 2018 Jan 31.

The Woven EndoBridge (WEB) for endovascular therapy of intracranial aneurysms: Update of a systematic review with meta-analysis.

Author information

1
Joint Department of Medical Imaging, University of Toronto, 610 University Avenue, Room 3-923, ON M5T 2M9, Toronto, Canada. Electronic address: taunoam@gmail.com.
2
Radiology Department, Rabin Medical Center (Beilinson Campus), Petach Tikva, Israel.
3
Hospices Civils de Lyon/UMR-CNRS 5510/MATEIS, Lyon, France.
4
Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France, University Claude Bernard Lyon 1, Lyon, France.
5
INSERM U1237, Physiology and Imaging of Neurological Disorders (PhIND), Cyceron, Boulevard Henri Becquerel, Caen, France.
6
Hospices Civils de Lyon/UMR-CNRS 5510/MATEIS, Lyon, France; University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England, United Kingdom.

Abstract

OBJECTIVES:

Endovascular treatment of wide-neck intracranial aneurysms (IAs) is challenging, especially in bifurcation location. The intra-saccular flow-disruptor Woven EndoBridge (WEB) offers a new concept of endovascular therapy for wide-neck IAs. We performed an update of a systematic review aimed to report the feasibility, effectiveness and safety of WEB device therapy.

PATIENTS AND METHODS:

A systematic review was conducted using several electronic databases (including PUBMED and EMBASE), searching for studies published between October 2015 and December 2017 (those published between January 2010 and September 2015 were included in our initial systematic review). Outcomes were: success of implantation, peri-procedural complications, mortality, and adequate occlusion (complete occlusion or neck remnant).

RESULTS:

In total (initial review + update), 12 uncontrolled case-series studies were included, reporting outcomes for 940 patients (68.6% female; mean age, 57 years) harboring 962 IAs. Most IAs were wide-neck bifurcation aneurysms (75%-100%), mainly at middle cerebral artery (37%) and anterior communicating artery (24.6%). Feasibility was 97% (95% confidence interval [CI], 95%-99%), and 9% (95%CI, 5%-14%) of cases required additional treatment. There were 14% (95%CI, 9%-19%) peri-procedural complications. After a median clinical follow-up of 7 months, mortality was 5% (95%CI, 1%-10%) and was higher in series with larger proportions of ruptured IAs. At last angiographic follow-up (median, 7 months; range, 3-27.9 months), adequate occlusion rate was 81% (95%CI, 73%-88%).

CONCLUSION:

Although WEB showed high rates of adequate aneurysm occlusion at mid-term, procedure-related complications and mortality rates were not negligible. Future studies should compare the WEB device with other treatment options.

KEYWORDS:

Embolization; Endovascular treatment; Intracranial aneurysm; Woven EndoBridge

PMID:
29408767
DOI:
10.1016/j.clineuro.2018.01.025
[Indexed for MEDLINE]

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