Su-Ming Zhang1, Lun-Xin Liu2, Peng-Wei Ren3, Xiao-Dong Xie4, Jia Miao1. 1. GCP Center/Institute of Drug Clinical Trials, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 2. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 3. Clinical Research Center for Respiratory Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 4. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: xiaodong_1962@163.com.
Abstract
OBJECTIVE: To assess the current efficacy, safety, and risk factors of the Woven EndoBridge (WEB) in treating wide-neck intracranial aneurysms. METHODS: We searched the PubMed, Ovid MEDLINE, and Embase databases between December 1, 2012 and June 30, 2018. Studies were included if they featured ≥5 patients undergoing WEB for wide-neck intracranial aneurysms, reported an angiographic or clinical outcome and risk factors, and were published after December 1, 2012. Major outcomes included initial or short-term complete and adequate occlusion. Secondary outcomes included treatment failure, recanalization, mortality, morbidity, and complication rates. A random-effect model was used to pool the data. To assess risk factors for short-term angiographic outcomes and the most common complications, we conducted subgroup analyses. RESULTS: We included 36 studies (1759 patients with 1749 aneurysms). The initial complete and adequate occlusion rates were 35% and 77%, respectively. The short-term (mean follow-up, 9.34 months) complete and adequate occlusion rates were 53% and 80%, respectively. Thromboembolism and recanalization had the highest occurrence (both 9%), followed by mortality (7%), morbidity (6%), failure (5%) and intraoperative rupture (3%). The following factors were related to higher short-term obliteration rates: unruptured status, in the anterior circulation, a medium neck (4-9.9 mm), newer-generation WEB, and treatment without additional devices. Ruptured status, anterior circulation, preoperative antiplatelet therapy, and newer-generation WEB were not significantly related to thromboembolism. CONCLUSIONS: WEB is safe and shows promising efficacy in treating wide-neck intracranial aneurysms. We preliminarily identified several risk factors for short-term angiographic outcomes.
OBJECTIVE: To assess the current efficacy, safety, and risk factors of the Woven EndoBridge (WEB) in treating wide-neck intracranial aneurysms. METHODS: We searched the PubMed, Ovid MEDLINE, and Embase databases between December 1, 2012 and June 30, 2018. Studies were included if they featured ≥5 patients undergoing WEB for wide-neck intracranial aneurysms, reported an angiographic or clinical outcome and risk factors, and were published after December 1, 2012. Major outcomes included initial or short-term complete and adequate occlusion. Secondary outcomes included treatment failure, recanalization, mortality, morbidity, and complication rates. A random-effect model was used to pool the data. To assess risk factors for short-term angiographic outcomes and the most common complications, we conducted subgroup analyses. RESULTS: We included 36 studies (1759 patients with 1749 aneurysms). The initial complete and adequate occlusion rates were 35% and 77%, respectively. The short-term (mean follow-up, 9.34 months) complete and adequate occlusion rates were 53% and 80%, respectively. Thromboembolism and recanalization had the highest occurrence (both 9%), followed by mortality (7%), morbidity (6%), failure (5%) and intraoperative rupture (3%). The following factors were related to higher short-term obliteration rates: unruptured status, in the anterior circulation, a medium neck (4-9.9 mm), newer-generation WEB, and treatment without additional devices. Ruptured status, anterior circulation, preoperative antiplatelet therapy, and newer-generation WEB were not significantly related to thromboembolism. CONCLUSIONS: WEB is safe and shows promising efficacy in treating wide-neck intracranial aneurysms. We preliminarily identified several risk factors for short-term angiographic outcomes.
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