Macquarie Neurosurgery
EBS presentationDate: 18 February 2016
Markus Wiedmann
To consider treatment of unruptured intracranial bifurcation aneurysms
with the Woven EndoBridge (WEB) device:Is this a good idea?
Background
Background
Endovascular treatment of broad necked bifurcation aneurysms is still
a challenge. New devices are being developed and introduced
continuously accepting uncertainty in the long term durability of
repair and the risk of the intervention as well as the device itself
during follow-up
Searchable question (PICO format)
P - Patients with unruptured intracranial aneurysmsI - Endovascular aneurysm treatment with the WEB device C - ?standard treatmentO - Aneurysm occlusion rate; durability of repair; peri- and post procedural complication rate;
clinical outcome (including long term outcome)
Q: What is the evidence for the use of the Woven EndoBridge (WEB) device in unruptured intracranial aneurysms ?
Search criteria
Search for cohort studies and case series of at least 10 cases. Keywords: WEB* (for: WEBs, WEB-SL, WEB-DL..); woven endo?bridge (for: Woven EndoBridge, woven endo brigde) and intracranial aneurysm (Mesh / Emtree terms) Databases: Medline, Embase, Scopus, clinicaltrials.gov
Search results - Embase
Search results - Medline
Search results - Scopus
Search results – Clinical trials
Search results – Google scholar (preliminary)
PRISMAIn
clud
ed
Medline33
Scre
enin
gEl
igib
ility
Embase71
14
Records screened76
Records excludedby title46
Studies included:WEBCAST and French
Observatory (multiple papers)
duplicates removed59
Scopus31
Records excludedby abstract
17
Studies found by cross referencing
1
Missed paper by search engines
Identified relevant papers
Results
• Two multicenter prospectively collected cohorts were identified
(WEBCAST and French Observatory)
• The aneurysms treated represent a selected subgroup of broad
necked bifurcation aneurysms
• There is no direct comparison to any other treatment
• No long term follow up is available yet
• Complete occlusion was achieved only in 56% of cases
• Additional treatment was required in about 10% of cases
• Antiplatelet therapy seems to be important to reduce
thromboembolic events
• Principal investigator for both cohorts (Pierot) is also consultant for
Sequent (WEB)
• Retreatment rate at 1 year was 3.6% (6.3% including attempted /
planned)
Conclusions
• The long-term durability of WEB repair is uncertain
• Studies focusing on unruptured broad necked bifurcation
aneurysms (specifically acoma and mca aneurysms) treated by
clipping should be published including long-term durability in order
to set a clear baseline that needs to be matched by new
treatments like WEB
• Neurosurgeons seem to become whiners
