The Woven EndoBridge device as a good alternative treatment for stent assisted coiling in intracranial bifurcation aneurysms: a systematic review and meta-analysis

ObjectivesThe Woven EndoBridge (WEB), functioning as an intrasaccular disruption device, offers a novel option for complex aneurysms, particularly bifurcation aneurysms. In this systematic review and meta-analysis, our goal is to compare the safety and efficacy of WEB devices with stent-assisted coiling (SAC) for intracranial bifurcation aneurysms.MethodsWe conducted a systematic search of PubMed, Scopus, and Embase, and Web of Science databases in September 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We aimed to compare aneurysmal occlusion, procedural time, the retreatment, and complication rates as secondary objectives. The comparison between the two techniques was performed using a weighted random-effects model, and the quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies.ResultsThe authors analyzed five studies encompassing 298 and 203 patients in SAC and WEB groups, respectively. Complete (OR, 0.97; 95%CI: 0.63-1.49, I2 = 0%) and adequate (OR: 0.88; 95%CI: 0.51-1.5, I2 = 0%) occlusion didn't differ between two groups. The overall procedural time mean difference was 38.2 min, significantly higher in the SAC group (95%CI, 26.9-49.6, I2 = 53.4%). Retreatment rates did not significantly differ between the two groups (OR: 1.34; 95%CI: 0.37-4.85, I2 = 61.7%). The SAC group experienced more complications during and after the operation (OR, 2.82; 95%CI: 1.07-7.44, I2 = 0%). The pooled follow-up duration was 22.1 and 13.5 months for SAC and WEB groups respectively.ConclusionThe WEB demonstrates comparable efficacy in occluding bifurcation aneurysms compared to SAC, with the added benefits of reduced procedural time and lower complication rates.