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Retreatment Rate and Strategies for Recurrent and Residual Aneurysms After Woven Endobridge (Web) Treatment: A Comprehensive Systematic Review and Meta-Analysis Publisher Pubmed



Mortezaei A1 ; Yazdanian F2 ; Mirahmadi Eraghi M3 ; Seraj FQM4 ; De Almeida RAA5 ; Saberian P6 ; Habibi MA7 ; Granstein JH2 ; Baharvahdat H8 ; Rahmani R9 ; Starke RM10
Authors
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Authors Affiliations
  1. 1. Gonabad University of Medical Sciences, Gonabad, Iran
  2. 2. Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States
  3. 3. School of Medicine, Islamic Azad University, Qeshm International Branch, Qeshm, Iran
  4. 4. Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
  5. 5. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
  6. 6. Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
  7. 7. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
  9. 9. Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
  10. 10. Department of Neurological Surgery, Radiology, Neurosciences, Pharmacology, University of Miami School of Medicine, Miami, FL, United States

Source: Neurosurgical Review Published:2025


Abstract

Woven Endo Bridge (WEB) is a flow diverter device used to treat wide-necked intracranial aneurysms. We conducted a systematic review and meta-analysis to determine the retreatment rate and strategies following aneurysmal recurrence after WEB treatment. A systematic literature search was conducted through four electronic databases. The Cochrane risk of bias tool for non-randomized trials (ROBINS-I) was used for risk of bias assessment. A meta-analysis and meta-regression were performed on relevant variables. A total of 29 studies with 2067 patients were included. Initially treated aneurysms had an adequate occlusion rate of 84.7% (20 studies, 980/1156, 95%CI: 79%—89%) at the last follow-up. The overall retreatment rate was 8.6% (24 studies, 251/2893, 95%CI: 6.5%—10.9%). Following retreatment, the immediate complete occlusion rate post retreatment and complete occlusion rate at last follow-up were 52% (six studies, 95%CI, 11%—91%) and 65% (six studies, 77/120, 95%CI: 56%—73%) respectively. Stent-assisted coiling achieved a 100% (95%CI: 57%—100%, P-value < 0.01) immediate adequate occlusion rate and 74% complete occlusion rate (95%CI: 16%—100%, P-value = 0.63) at last follow-up, which was higher than clipping, coiling, and flow diversion. On meta-regression, aneurysm height and neck width significantly associated with higher retreatment rate. The current meta-analysis showed a 9% retreatment rate after initial aneurysms treatment with WEB and overall adequate retreatment occlusion was high. Although stent-assisted coiling showed a higher adequate occlusion rate post-operatively, there was no significant difference between retreatment strategies in long-term radiological outcomes. © The Author(s) 2025.
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