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