Motawei, Ahmed Sallam

Background Wide neck bifurcation aneurysms (WNBAs) are a subtype of aneurysms that are especially complex to treat. We aim to conduct a systematic review and meta-analysis to synthesize the available literature on the safety and efficacy of employing endovascular clip system (eCLIPs) in the treatment of WNBAs. Methods We report this study in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. PubMed, Embase, Web of Science, and Scopus were queried for this review. Screening and extraction were performed by at least two authors to ensure accuracy and completeness, and a senior author arbitrated any discrepancies. All data were analyzed using R software version 4.3.0. and random-effects model. Results Four studies were finally included, of which three were prospective and one was retrospective. Successful adjunctive coiling occurred in 91.38% (95% CI = 70.71–97.9) of cases and overall technical success was achieved in 88.61% (95 CI = 75.54–95.15) of cases. The pooled complete occlusion (Raymond-Roy Class I) was 50.65% (95% CI = 39.63–61.60) and adequate occlusion (Raymond-Roy Class I/II) was 84.42% (95% CI = 74.53–90.93). Thrombo-embolic complication had a pooled rate of 1.22% (95% CI = 0.17–8.15), retreatment rate was 6.10% (95% CI = 2.56–13.83), and mortality reported in 3.66% (95% CI = 1.18–10.74) of patients. Conclusion The use of eCLIPs may be a safe and efficacious treatment for WNBAs. Future randomized controlled trials are needed for further validation of the findings.

Introduction Background: The Woven Endo‐Bridge (WEB) device is an intrasaccular device being used to secure intracranial aneurysms through the endovascular approach. The WEB is commonly used for wide‐neck aneurysms. There are no comprehensive studies to assess the low‐profile device WEB 17 so far. Although, some single studies have reported their early experience using the device. We plan to provide a comprehensive assessment of the early center experience using the WEB 17 device to secure intracranial aneurysms. Objective: To provide an overview of the early‐center experience of the 0.017‐inch endovascular Woven EndoBridge device (WEB‐17) device. Methods A systematic review and meta‐analysis were conducted following the PRISMA recommendations. On April 15, 2023, we searched for eligible papers in Pubmed, Web of Science (ISI), Scopus, and Embase databases. The meta‐analysis was done using R software version 4.3.0. and the "meta" package. Pooled prevalence (%) and their corresponding 95% confidence intervals (CI), random‐effects model based and the generalized linear mixed models (GLMMs) method. On the presence of multiple follow‐up points, we included the last available in the analysis. Complete occlusion was defined as Raymond–Roy occlusion classification (RROC) class I, and adequate occlusion was defined as RROC class I or II. Results Seven studies were finally included following the double‐reviewer screening of the retrieved literature. The patients' mean age ranged from 52.5±13.8 to 62.0±9.5 years, and 71.0% were females. The mean follow‐up duration ranged from 6±2.25 months to 11.6±4. Technical success was achieved in 98.34% (95% CI= 96.72‐99.17) of the cases, while adjunctive devices were used in 4.97% (95% CI= 1.60‐14.39) of them (Figure 1). The complete occlusion rate was 72.54% (95% CI= 63.44‐80.08) (Figure 2), while the adequate occlusion rate was 94.41 (95% CI= 88.17‐97.46) (Figure 3). There was no significant heterogeneity in all pooled outcomes. Conclusion The early experience of the device shows an efficacy profile comparable with the currently available devices in treating intracranial aneurysms.

Background The Woven Endo-Bridge (WEB) device revolutionized the treatment of wide-necked bifurcation aneurysms by intrasaccular flow diversion. The latest advancement is the WEB-17 system, offering greater flexibility with fewer wires, enabling treatment of smaller distal aneurysms using smaller microcatheters than the WEB-21 system. Methods We conducted a systematic review following preferred reporting items for systematic reviews and meta-analyses guidelines, analyzing data from seven retrospective cohort studies involving 483 aneurysms treated with the WEB-17 device. Statistical analysis computed pooled prevalence rates and 95% confidence intervals using appropriate models for each outcome and R software version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria). Results Technical success was achieved in 475 out of 483 aneurysms treated with the WEB-17 device, with a success rate of 98.34% (95% confidence interval (CI) = 96.72–99.17). Among the successful cases, 4.97% (95% CI = 1.60–14.39) required adjunctive devices. Adequate occlusion, defined as complete occlusion or neck remnants, was observed in 94.41% (95% CI = 88.17–97.46) of cases. Periprocedural complications were infrequent, with thromboembolic complications occurring in 4.93% (95% CI = 3.29–7.30) of cases, hemorrhagic complications in 1.28% (95% CI = 0.58–2.83), and postprocedural neurologic complications in 0.99% (95% CI = 0.31–3.14). Procedure-related morbidity was observed in 1.71% (95% CI = 0.86–3.39) of cases, and there was one procedure-related mortality reported at 0.21% (95% CI = .03–1.50). Mortality unrelated to the procedure occurred in 1% (95% CI = 0.23–4.15). Conclusion Our findings suggest that the WEB-17 device is associated with a high rate of technical success, favorable angiographic outcomes, and a low rate of periprocedural complications. Further research, including prospective trials, is needed to confirm these findings and establish its safety and efficacy definitively.