Abstract
The prevalence of recurrent and residual aneurysms following Woven EndoBridge (WEB) treatment is not insignificant. The goal of this systematic review was to evaluate retreatment methods for such aneurysms and their outcomes. PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Original studies reporting on aneurysms that were retreated after WEB were included. Sixteen studies (n = 901 aneurysms), of which three were prospective, reported on retreated aneurysms following initial WEB treatment. Of those 901 aneurysms, on average 18.7 ± 11.5% were recurrent or residual at the last follow-up and 10.7 ± 11% required some form of retreatment. When compared to WEB-IT (WEB Intra-saccular Therapy) data, retreated aneurysms were more likely to be large in size (p < 0.0001) and more likely to have been initially treated with the WEB dual-layer configuration. The mean age of those with retreated aneurysms was 58 ± 5.7 years old, and the mean size of aneurysm dome was 11.1 ± 5.5 millimeters. Majority (34.1%) of the aneurysms were located at the basilar apex. Retreatment modalities included coiling (20%), stent-assisted coiling (38.7%), additional WEB device (13.3%), flow diversion (16%), and clipping (12%). Majority of retreated cases had favorable outcomes, with 96.4 ± 13.4% of the cases demonstrating technical success and 90.5 ± 18.2% having adequate occlusion at the last follow-up. Our systematic review suggests that retreatment of recurrent and residual aneurysms after initial WEB treatment is feasible. Future prospective studies would be helpful in validating these results.
Highlights
BackgroundThe field of neuroendovascular aneurysm treatment has been rapidly evolving, with some of the most recent advancements being in the field of flow diversion
A systematic review focusing on retreated aneurysms following initial Woven EndoBridge (WEB) therapy has not been completed; the aim of this systematic review was to explore the evidence in the current literature reporting on retreatment strategies for such aneurysms and their subsequent outcomes
16 studies were found to report on retreated aneurysms after WEB therapy and those 16 studies were eligible for the systematic review (Figure 1) [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]
Summary
BackgroundThe field of neuroendovascular aneurysm treatment has been rapidly evolving, with some of the most recent advancements being in the field of flow diversion. Intra-saccular flow diversion is the most recent advancement in technology for the treatment of such aneurysms. Woven EndoBridge (WEB; Sequent Medical, Aliso Viejo, CA, USA), a nitinol-based self-expanding mesh implant, is the only FDA-approved intra-saccular flow diverter device on the market today for the treatment of wide neck bifurcation aneurysms. It is imperative to be familiar with the retreatment strategies that can be helpful in managing these aneurysms. To this day, a systematic review focusing on retreated aneurysms following initial WEB therapy has not been completed; the aim of this systematic review was to explore the evidence in the current literature reporting on retreatment strategies for such aneurysms and their subsequent outcomes
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