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Woven EndoBridge (WEB) vs Stent assisted coiling (SAC) in treatment of intracranial bifurcation aneurysms- A systematic review and meta-analysis.

Friday, May 3, 2024

Presenting Author(s)

Sanjeev Sreenivasan

Clinical Fellow
Neurosurgical Oncology, Northwell Health
Manhasset, NY, US

Co-Author(s)

GG

Gaurav Gupta, MD

Associate Professor - Neurosurgery
Rutgers University, Robert Wood Johnson Medical School, New Jersey, United States
SK

Siddhant Kumarapuram, BS

Medical Student
RUTGERS, United States
Anil Nanda, MD,MBA

Professor
RUTGERS, United States
sR

sudipta Roychowdhury, MD

Clinical Professor of Radiology, Neurosurgery and Neurology
Rutgers University, Robert Wood Johnson Medical School, New Jersey, United States
PS

Pranav Sathuvalli, BS

Medical Student
RUTGERS, United States
Sanjeev Sreenivasan

Clinical Fellow
Neurosurgical Oncology, Northwell Health
Manhasset, NY, US

Introduction: Advances in endovascular technology has created newer options for treatment of intracranial bifurcation aneurysms. Woven Endo bridge (WEB) device has been a revelation compared to the gold standard Stent-assisted coiling (SAC). The optimal device/ technique yet remains unknown.

Methods: A systematic review of literature was conducted from inception to May 2023. PubMed and Google Scholar were queried for terms ‘bifurcation aneurysms’, ‘endovascular’, ‘woven Endo bridge’, ‘ICA bifurcation’, ‘MCA bifurcation’, basilar bifurcation, ‘anterior communicating artery (ACOM)’. Studies with only more than 10 cases were included. Primary outcome was angiographic occlusion rates (Raymond Roy (RR)). Secondary outcomes were long-term occlusion rates and complications.

Results: WEB group
Ten studies with 766 patients were included. The aneurysm was located along bifurcation of ICA in 217, Acom in 204, MCA in 317, basilar in 128. Mean aneurysm height was 6.88 mm, mean width was 5.54. Mean Aspect ratio was 1.47. Aneurysms were ruptured in 154 and unruptured in 612. Mean follow up was 14.23 months. RR 1 occlusion was seen in 55.6% (n=426), RR2 in 31.3%(n=240) and RR3 in 8.4% (n=65). Retreatment was needed in 25(3.2%) and 1.3% (n=10) mortality was noticed.
SAC group
Twenty-one studies with 1325 patients were included. Mean age was 56.48. The aneurysms were located along ICA bifurcation in 42, Acom 287, MCA bifurcation 426, basilar 264. Mean aneurysm height was 7.62mm, mean width 5.8mm. Aneurysms were ruptured in 287 and unruptured in 1038. Mean follow-up was 55.5 months. RR1 occlusion was seen in 929 (70.1%), RR2 in 100 (7.54%), RR3 in 82 (6.1%). Retreatment was needed in 29 (2.1%) and mortality was seen in 6(0.5%).

Conclusion : Significant difference in follow-up times and aneurysm types treated with WEB and SAC was noticed. Higher RR1 occlusion was noticed over a longer-term follow up in patients who underwent SAC.