Abstract：
OBJECTIVE: The recent introduction of the Woven EndoBridge (WEB) has presented an alternative treatment modality for intracranial bifurcation and wide-neck aneurysms with a growing body of literature evaluating its efficacy. However, no previous systematic review has focused on comparing WEB with previously using endovascular approaches, specifically primary coiling (PC) and stent-assisted coiling (SAC). Herein, the authors present the first systematic review summarizing available literature to reach a consensus regarding the safety and effectiveness of WEB.
METHODS: A systematic review of articles identified through a search of PubMed, Embase, Scopus, and Web of Science was conducted. Studies were included if they compared WEB with PC or SAC from any aspect for intracranial aneurysms. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies-of Interventions tool. Meta-analyses of the outcomes based on stent use and rupture status were performed.
RESULTS: A total of 16 studies were included. The three endovascular approaches were comparable in terms of baseline characteristics except for older age and smaller aneurysm neck in the PC group (p < 0.05). Moreover, the follow-up duration was shorter in the WEB group (p < 0.05). Although the WEB group demonstrated lower complete and adequate immediate occlusion rates (p < 0.01), the rates at follow-up evaluations were comparable with SAC and PC (p = 0.61 and p = 0.27, respectively). The WEB group experienced significantly fewer unfavorable neurological outcomes than the SAC group (p = 0.04), while comparable to the PC group (p = 0.36). Retreatment rates were comparable between WEB and coiling (p = 0.92). The WEB group had fewer hemorrhagic and thromboembolic complications (p < 0.01 and p = 0.01, respectively), with similar neurological and procedure-related complications compared with combined PC and SAC groups. Lastly, mortality was comparable among the different endovascular approaches.
CONCLUSIONS: This study provides evidence on the noninferiority of WEB compared with PC and SAC in terms of angiographic outcomes. Meanwhile, our findings on lower complication rates, cost, and improved operative aspects associated with WEB establish this novel endovascular treatment as a safe and effective alternative for the treatment of bifurcation and wide-neck aneurysms.
METHODS: A systematic review of articles identified through a search of PubMed, Embase, Scopus, and Web of Science was conducted. Studies were included if they compared WEB with PC or SAC from any aspect for intracranial aneurysms. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies-of Interventions tool. Meta-analyses of the outcomes based on stent use and rupture status were performed.
RESULTS: A total of 16 studies were included. The three endovascular approaches were comparable in terms of baseline characteristics except for older age and smaller aneurysm neck in the PC group (p < 0.05). Moreover, the follow-up duration was shorter in the WEB group (p < 0.05). Although the WEB group demonstrated lower complete and adequate immediate occlusion rates (p < 0.01), the rates at follow-up evaluations were comparable with SAC and PC (p = 0.61 and p = 0.27, respectively). The WEB group experienced significantly fewer unfavorable neurological outcomes than the SAC group (p = 0.04), while comparable to the PC group (p = 0.36). Retreatment rates were comparable between WEB and coiling (p = 0.92). The WEB group had fewer hemorrhagic and thromboembolic complications (p < 0.01 and p = 0.01, respectively), with similar neurological and procedure-related complications compared with combined PC and SAC groups. Lastly, mortality was comparable among the different endovascular approaches.
CONCLUSIONS: This study provides evidence on the noninferiority of WEB compared with PC and SAC in terms of angiographic outcomes. Meanwhile, our findings on lower complication rates, cost, and improved operative aspects associated with WEB establish this novel endovascular treatment as a safe and effective alternative for the treatment of bifurcation and wide-neck aneurysms.
摘要：
目的：最近推出的WovenEndoBridge（WEB）为颅内分叉和宽颈动脉瘤提供了一种替代治疗方式，越来越多的文献评估了其疗效。然而,以前没有系统评价集中在与以前使用血管内方法进行比较，特别是一次卷绕（PC）和支架辅助卷绕（SAC）。在这里，作者提出了第一份系统综述,总结了现有文献,以就WEB的安全性和有效性达成共识.
方法：对通过搜索PubMed，Embase,Scopus,进行了WebofScience。如果他们从颅内动脉瘤的任何方面与PC或SAC进行比较，则包括研究。使用非随机研究-干预工具中的偏倚风险评估偏倚风险。根据支架使用和破裂状态对结果进行Meta分析。
结果：共纳入16项研究。3种血管内方法在基线特征方面具有可比性,除了PC组中年龄较大和动脉瘤颈部较小(p<0.05)。此外，WEB组随访时间较短(p<0.05)。尽管WEB组表现出较低的完全和足够的即时闭塞率（p<0.01），随访评估时的比率与SAC和PC相当(分别为p=0.61和p=0.27).与SAC组相比，WEB组的神经系统不良结局明显较少（p=0.04），而与PC组相当(p=0.36)。退税率与卷取相比(p=0.92)。WEB组出血性和血栓栓塞性并发症较少(分别为p<0.01和p=0.01),与PC和SAC联合组相比，神经系统和手术相关并发症相似。最后,不同血管内入路的死亡率相当.
结论：本研究提供了与PC和SAC相比，WEB在血管造影结果方面的非劣效性的证据。同时,我们发现并发症发生率较低，成本,与WEB相关的改进的手术方面确立了这种新颖的血管内治疗作为治疗分叉和宽颈动脉瘤的安全有效的替代方法。
方法：对通过搜索PubMed，Embase,Scopus,进行了WebofScience。如果他们从颅内动脉瘤的任何方面与PC或SAC进行比较，则包括研究。使用非随机研究-干预工具中的偏倚风险评估偏倚风险。根据支架使用和破裂状态对结果进行Meta分析。
结果：共纳入16项研究。3种血管内方法在基线特征方面具有可比性,除了PC组中年龄较大和动脉瘤颈部较小(p<0.05)。此外，WEB组随访时间较短(p<0.05)。尽管WEB组表现出较低的完全和足够的即时闭塞率（p<0.01），随访评估时的比率与SAC和PC相当(分别为p=0.61和p=0.27).与SAC组相比，WEB组的神经系统不良结局明显较少（p=0.04），而与PC组相当(p=0.36)。退税率与卷取相比(p=0.92)。WEB组出血性和血栓栓塞性并发症较少(分别为p<0.01和p=0.01),与PC和SAC联合组相比，神经系统和手术相关并发症相似。最后,不同血管内入路的死亡率相当.
结论：本研究提供了与PC和SAC相比，WEB在血管造影结果方面的非劣效性的证据。同时,我们发现并发症发生率较低，成本,与WEB相关的改进的手术方面确立了这种新颖的血管内治疗作为治疗分叉和宽颈动脉瘤的安全有效的替代方法。
