Background Compared to stent-assisted coiling the Woven EndoBridge (WEB) device offers the advantage of treatment of wide-necked aneurysms without antiplatelet medications. However, the safety and efficacy of WEB is yet to be fully defined in the setting of aneurysmal subarachnoid hemorrhage (aSAH), given concerns regarding the delayed nature of aneurysm thrombosis.
Methods The search protocol was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search using the OVID Medline, Embase, Web of Science, and Cochrane Library databases from inception to February 2020 was performed using relevant key words to identify cases of aSAH that were treated with WEB. The primary outcome measure was radiographic complete occlusion rates. Secondary outcomes included rebleeding and complications rates. All pooled event rates were calculated using random effect model.
Results Six articles, all of which were observational case series, representing 261 ruptured aneurysms were included for analysis (average follow up time was 4 months). Most of these aneurysms were in the anterior circulation (>60%). The likelihood of a complete radiographic occlusion following WEB for ruptured aneurysms was 66.6% (95% CI 47–74%). Rebleeding rates were 2.8% (95% CI 1–6%). The pooled event rate for complications (procedural aneurysm rupture, thromboembolic, and device protrusion in the parent artery) across five studies was 17.9% (95% CI 9–32%). Overall retreatment rates were 10% (95% CI 4–22%) and the need for early or delayed stent placement was 5% (95% CI 1–12%). There was no significant heterogeneity between studies in rebleeding and stent placement outcomes (I2 <25%).
Conclusion The WEB device in aSAH appears to provide similar protection against rebleeding and retreatment rates that are comparable to traditional approaches; however, there is a higher rate of incomplete radiographic occlusion and operative complications. Long-term prospective studies are needed to fully delineate the role of WEB embolization in aSAH.
Disclosures N. Alotaibi: None. P. Harker: None. F. Robertson: None. J. Vranic: None. M. Koch: None. C. Stapleton: None. T. Leslie-Mazwi: None. A. Patel: None.
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