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The Woven EndoBridge device for ruptured intracranial aneurysms: international multicenter experience and updated meta-analysis

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

The Woven EndoBridge (WEB) can be used to treat wide-necked aneurysms without antiplatelet medications, suggesting it may have advantages in the setting of aneurysmal subarachnoid hemorrhage (aSAH). The goal was assessment of safety and efficacy of WEB in aSAH given the delayed nature of aneurysmal thrombosis.

Methods

An international retrospective analysis of patients with aSAH treated with WEB was conducted at 7 tertiary centers from 2016 to 2020. Outcomes included rates of rebleeding, retreatment, complications, and complete occlusion. Furthermore, a systematic review and meta-analysis was conducted from 2011 to 2020 assessing the same outcomes. All pooled event rates were calculated using a random effect model.

Results

Consecutive patients with aSAH harbored 25 aneurysms that were treated with 29 WEB devices. The mean age was 53 years, and 65% were female. Zero experienced rebleeding, 2 were retreated, 2 experienced complications, 16 were completely occluded at 3 months, and 21 were completed occluded at 9–12 months. Meta-analysis of 309 WEB treatments for aSAH from 7 case series revealed 2.5% (95% CI 1–5%) had rebleeding, 9% (95% CI 4–17%) were retreated, 17% (95% CI 10–30%) had complications, and 61% (95% CI 51–71%) were completely occluded at 3–6 months.

Conclusion

WEB embolization in the setting of aSAH provides similar protection against rebleeding with comparable retreatment rates to traditional approaches. However, there is a higher rate of incomplete radiographic occlusion and operative complications compared to WEB embolization of unruptured aneurysms. Long-term prospective studies are needed to fully delineate the role of WEB embolization in aSAH.

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Abbreviations

ACoA:

Anterior communicating artery

aSAH:

Aneurysmal subarachnoid hemorrhage

BTA:

Basilar tip aneurysms

CI:

Confidence intervals

DAPT:

Dual antiplatelet therapy

FDA:

Food and Drug Administration

ICA:

Internal carotid artery

ICH:

Intracranial hemorrhage

MCA:

Middle cerebral artery

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

TIA:

Transient ischemic attack

WEB:

Woven EndoBridge

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Funding

RWR was supported by National Institute of Health [NIH-NINDS R25NS065743].

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA

    Pablo Harker, Robert W. Regenhardt, Naif M. Alotaibi, Justin Vranic, Faith C. Robertson, Matthew Koch, Christopher J. Stapleton, Thabele M. Leslie-Mazwi & Aman B. Patel

  2. Department of Neurosurgery, King Fahad Medical City, National Neuroscience Institute, Riyadh, Saudi Arabia

    Naif M. Alotaibi

  3. Neuroradiology & Neurointervention Service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Adam A. Dmytriw

  4. Departments of Medical Imaging and Neurosurgery, University of Toronto, Toronto, ON, Canada

    Adam A. Dmytriw & Jerry C. Ku

  5. AngioTeam Cerebrovascular, Endovascular Neurosurgery and Neuroradiology, Medellin, Colombia

    Nelson Serna, Boris Pabon & Juan A. Mejia

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  1. Pablo Harker
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Contributions

Conception and design: Alotaibi; acquisition of data: Alotaibi, Harker; analysis and interpretation of data: all authors; drafting the article: Harker, Alotaibi, Regenhardt; critically revising the article: all authors; reviewed submitted version of manuscript: all authors; approved the final version of the manuscript on behalf of all authors: Harker; statistical analysis: Alotaibi; and study supervision: Patel.

Corresponding author

Correspondence to Adam A. Dmytriw.

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Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Conflict of interest

AB Patel: Consultant for Penumbra, MicroVention, and Medtronic. B Pabon: Consultant for MicroVention. The remaining authors declare that they have no conflict of interest.

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Harker, P., Regenhardt, R.W., Alotaibi, N.M. et al. The Woven EndoBridge device for ruptured intracranial aneurysms: international multicenter experience and updated meta-analysis. Neuroradiology 63, 1891–1899 (2021). https://doi.org/10.1007/s00234-021-02727-6

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