Wiedmann ebs

1. Macquarie Neurosurgery
EBS presentation
Date: 18 February 2016
Markus Wiedmann
To consider treatment of unruptured intracranial
bifurcation aneurysms
with the Woven EndoBridge (WEB) device:
Is this a good idea?

2. Background

3. Background
Endovascular treatment of broad necked bifurcation aneurysms is still
a challenge. New devices are being developed and introduced
continuously accepting uncertainty in the long term durability of repair
and the risk of the intervention as well as the device itself during
follow-up

4. Searchable question (PICO format)
P - Patients with unruptured intracranial aneurysms
I - Endovascular aneurysm treatment with the WEB device
C - ?standard treatment
O - Aneurysm occlusion rate; durability of repair; peri- and post procedural complication rate;
clinical outcome (including long term outcome)
Q: What is the evidence for the use of the Woven EndoBridge (WEB)
device in unruptured intracranial aneurysms ?

5. Search criteria
Search for cohort studies and case series of at least 10 cases.
Keywords: WEB* (for: WEBs, WEB-SL, WEB-DL..); woven endo?bridge (for: Woven
EndoBridge, woven endo brigde) and intracranial aneurysm (Mesh / Emtree terms)
Databases: Medline, Embase, Scopus, clinicaltrials.gov

6. Search results - Embase

7. Search results - Medline

8. Search results - Scopus

9. Search results – Clinical trials

10. Search results – Google scholar (preliminary)

11. PRISMA
Included
Medline
33
ScreeningEligibility
Embase
71
14
Records screened
76
Records excluded
by title
46
Studies included:
WEBCAST and French
Observatory (multiple papers)
duplicates removed
59
Scopus
31
Records excluded
by abstract
17
Studies found by
cross referencing
1

12. Missed paper by search engines

13. Identified relevant papers

14. Results
• Two multicenter prospectively collected cohorts were identified
(WEBCAST and French Observatory)
• The aneurysms treated represent a selected subgroup of broad
necked bifurcation aneurysms
• There is no direct comparison to any other treatment
• No long term follow up is available yet
• Complete occlusion was achieved only in 56% of cases
• Additional treatment was required in about 10% of cases
• Antiplatelet therapy seems to be important to reduce
thromboembolic events
• Principal investigator for both cohorts (Pierot) is also consultant for
Sequent (WEB)
• Retreatment rate at 1 year was 3.6% (6.3% including attempted /
planned)

15. Conclusions
• The long-term durability of WEB repair is uncertain
• Studies focusing on unruptured broad necked bifurcation
aneurysms (specifically acoma and mca aneurysms) treated by
clipping should be published including long-term durability in order
to set a clear baseline that needs to be matched by new
treatments like WEB
• Neurosurgeons seem to become whiners