Systematic Review of Woven EndoBridge for Wide-Necked Bifurcation Aneurysms: Complications, Adequate Occlusion Rate, Morbidity, and Mortality

Background

Although the Woven EndoBridge (WEB [Sequent Medical, Aliso Viejo, California, USA]) is a highly innovative technique for the endovascular treatment of wide-necked bifurcation aneurysms (WNBAs), there are no studies available comparing this technique with surgical results or other endovascular results of stent-assisted coiling or balloon-assisted coiling for WNBAs. The purpose of this study was to assess complications, complete occlusion rate, and morbidity and mortality of the WEB in WNBA treatment.

Methods

Published literature citing embolization results for WNBAs using the WEB was reviewed. A systematic review was performed to evaluate the complications, complete occlusion rate, and morbidity and mortality.

Results

We identified 19 studies, including 935 patients. The most frequent aneurysm locations were the bifurcation of the middle cerebral artery (MCA) (42.8%), the anterior communicating artery (23%), and the basilar bifurcation (20.8%). The technical success rate of the WEB was 97% (95% confidence interval [CI], 96%–98%). The thromboembolic complication rate was 8% (95% CI, 6%–11%). The thromboembolic complication rate was 10% (95% CI, 7%–13%) in cases before 2013, which was higher than in cases after 2013 (6%; 95% CI, 4%–9%; P = 0.045). MCA bifurcation aneurysm has a higher thromboembolic complication rate than posterior circulation aneurysm. The overall bleeding complication rate of the WEB was 2% (95% CI, 1%–3%). The adequate occlusion rate was 81% (95% CI, 76%–85%). Morbidity during follow-up was 3% (95% CI, 1%–4%) (I² = 30.4%), and mortality was 2% (95% CI, 1%–3%).

Conclusions

Adequate aneurysm occlusion was found in 81% of WEB cases with low morbidity and mortality.

Introduction

Wide-necked bifurcation aneurysms (WNBA) are difficult to be treated endovascularly because bifurcation branches often arise from the aneurysm neck.¹ This subgroup of aneurysms includes aneurysms located at internal carotid artery bifurcation, middle cerebral artery bifurcation, anterior communicating artery, and basilar artery bifurcation.¹ Different strategies are available to treat both ruptured and unruptured aneurysms (stent-assisted coiling, Y-stenting, waffle-cone technique, and flow diversion), whereas some techniques are essentially restricted to unruptured aneurysms because of the need of concomitant use of antiplatelet medications.¹ However, these techniques have yet to be evaluated in large prospective series. An intrasaccular flow disruption device (Woven EndoBridge [WEB] [Sequent Medical, Aliso Viejo, California, USA]) seems to be a promising tool for the endovascular treatment of WNBAs.2, 3, 4, 5 The WEB device has been evaluated with prospective multicenter studies showing high safety and good efficacy. However, the potential safety issues of this technique have to be assessed. It would be interesting to assess the effectiveness of WEB embolization and how it impacts the conventional endovascular techniques for WNBAs. Although 3 systematic reviews have been performed, these questions have not been answered clearly. There are no studies available comparing this technique with surgical results or other endovascular results of stent-assisted coiling or balloon-assisted coiling for WNBAs. In this review, we evaluated complications, complete occlusion rate, and morbidity and mortality of the WEB in WNBA treatment.