Addressing Aneurysm Recurrence Post-woven Endobridge Device Treatment: A Systematic Review and Meta-analysis

Introduction: Early literature on the Woven EndoBridge (WEB) device report 80-90% adequate aneurysm occlusion, yet the rate of complete occlusion remains low, ranging from 40-55%. It is uncertain whether the high prevalence of residual or recurrent aneurysms requires additional treatment to prevent rupture during follow-up, and the optimal intervention modality for managing such cases remains to be determined. We systematically reviewed the literature to meta-analyze complete occlusion, complication, and retreatment rates after endovascular or microsurgical retreatment for aneurysm recurrences or remnants post-WEB.

Methods: PubMed and Embase were queried for ‘retreatment’ of ‘recurrent’ or ‘residual’ aneurysms treated with the WEB. Studies reporting retreatment strategies and outcomes were included. Patient characteristics, aneurysm locations and sizes, outcomes, recurrence rates, and complications were extracted. Meta-analyses were conducted on variables reported by ≥3 studies.

Results: We included 15 studies of 220 patients (220 aneurysms) with a mean age of 57.8 years (95% confidence interval [CI]:55.1–60.7 years). At baseline, 42.8%(95%CI:35–51%) of aneurysms were ruptured, had a mean 8.6mm(95%CI:7.3-10mm) dome and a mean 5.2mm(95%CI:4.7–5.7mm) neck, and were predominantly at bifurcations (69.85%, 95%CI47.63-85.51). On mean 11.2-month follow-up(95%CI:8–15.6months), 28.7%(95%CI:22.2–36.3%) had neck remnants and 75.9%(95%CI:66.1–83.5%) had residual dome filling, predominantly due to incomplete occlusion in 84.7% of cases(95%CI:66.6–93.9%). Endovascular management was used in 82.5%(95%CI:72.6–89.3%) of these recurrences, with stent- or flow diverter-assisted coil embolization being used in 42.4%(95%CI:32.7–52.8%). Overall, complication rates were 8.9%(95%CI:4.9–15.6%) thromboembolic and 8%(95%CI:4.3–14.2%) device-related. Complete angiographic occlusion after retreatment was achieved in 64.1%(95%CI:52.6–74.2%), of patients, with 15.2%(95%CI:8.8–24.9%) requiring additional retreatment.

Conclusion : In our review, management of aneurysm recurrences depended on remnant morphology. Procedural safety was the focus more than final occlusion rate post-retreatment. Endovascular management resulted in comparable occlusion and retreatment rates, suggesting its expanding role in treating these recurrences.