Adil Ahmed, Ocílio Ribeiro Gonçalves, Paweł Łajczak, Kenzo Ogasawara Donato, Maria Antonia Oliveira Machado Pereira, Filipe Virgilio Ribeiro, Anderson Matheus Pereira da Silva, Jose Fernando Olvera-Castro, João Vitor Andrade Fernandes, Muhammad Nawaz Khan, Syed Sarmad Bukhari
MSC offers the most durable occlusion, whereas WEB and SAC are less invasive, with WEB showing better safety than SAC but lower durability than MSC, supporting individualized, evidence-based treatment.
BACKGROUND: Endovascular techniques and devices, including Woven EndoBridge (WEB) and stent-assisted coiling (SAC), expand the choice of therapies for complex aneurysms, while the evidence directly comparing them to microsurgical clipping (MSC) remains very limited. This meta-analysis compares the safety and efficacy of WEB vs SAC and MSC in patients with ruptured and unruptured intracranial aneurysms.
METHODS: This study followed PRISMA guidelines. A comprehensive search of PubMed, Embase, and Scopus identified comparative cohort studies of WEB vs SAC and MSC for wide-neck intracranial aneurysms. Outcomes included occlusion, favorable functional/neurological outcome, defined as a modified Rankin Scale (mRS) score of 0-2, complications, and mortality. Statistical analyses were performed in R Studio. Heterogeneity was assessed with I2 and leave-one-out (LOO) sensitivity, and publication bias with funnel plots and Egger's test.
RESULTS: Seventeen observational studies with a total of 2289 patients were included. When compared with mechanical circulatory support (MSC), the WEB device was associated with lower rates of adequate occlusion (RR 0.77; 95% CI 0.69-0.86; P < .001) and higher rates of incomplete occlusion (RR 4.61; 95% CI 2.12-10.01; P < .001). No significant differences were found in mortality or favorable neurological outcomes (defined as modified Rankin Scale [mRS] 0-2). In comparisons with stent-assisted coiling (SAC), the WEB device showed similar rates of complete occlusion (RR 0.98; P = .617), retreatment (RR 0.79; P = .508), and thromboembolic complications (RR 0.59; P = .137). The WEB device did demonstrate a significantly lower incidence of procedure-related complications (RR 0.49; 95% CI 0.29-0.85; P = .011).
CONCLUSION: MSC offers the most durable occlusion, whereas WEB and SAC are less invasive, with WEB showing better safety than SAC but lower durability than MSC, supporting individualized, evidence-based treatment.