title: Endovascular Treatment of Intracranial Aneurysms with the WEB Device: A Systematic Review of Clinical Outcomes.
abstract: Despite the improvement in technology, endovascular treatment of bifurcation intracranial wide-neck aneurysms remains challenging, mainly due to the difficulty of maintaining coils within the aneurysm sac without compromising the patency of bifurcation arteries. The Woven EndoBridge (WEB) device is a recent intrasaccular braided device specifically dedicated to treating such aneurysms with a wide neck by disrupting the flow in the aneurysmal neck and promoting progressive aneurysmal thrombosis.
  
  
  
  Using several health data bases, we conducted a systematic review of all published studies of WEB endovascular treatment in intracranial aneurysms from 2010 onward to evaluate its efficacy and safety profile.
  
  
  
  The literature search identified 6 relevant studies (7 articles) including wide-neck bifurcation aneurysms in ≥80% of cases. Clinical data supporting the efficacy and safety of the WEB are limited to noncomparative cohort studies with large heterogeneity from a methodologic standpoint. The WEB deployment was feasible with a success rate of 93%-100%. Permanent morbidity (mRS of >1 at last follow-up) and mortality were measured at 2.2%-6.7% and 0%-17%, respectively. The adequate occlusion rate (total occlusion or neck remnant) varied between 65% and 85.4% at midterm follow-up (range, 3.3-27.4 months).
  
  
  
  Endovascular treatment of bifurcation wide-neck aneurysms with the WEB device is feasible and allows an acceptably adequate aneurysm occlusion rate; however, the rate of neck remnants is not negligible. The WEB device needs further clinical and anatomic evaluation with long-term prospective studies, especially of the risk of WEB compression. Prospective controlled studies should be encouraged.
authors.affiliation: From the Délégation à la Recherche Clinique et à l'Innovation (X.A.), Hospices Civils de Lyon, Cellule Innovation, Lyon, France CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France.
authors.forename: X
authors.identifier: 0000-0002-2145-6723
authors.initials: X
authors.lastname: Armoiry
authors.affiliation: Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France Centre de Neurosciences Cognitives (F.T., B.G.), CNRS, UMR 5229, Lyon, France.
authors.forename: F
authors.identifier: 0000-0001-5006-2320
authors.initials: F
authors.lastname: Turjman
authors.affiliation: CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France.
authors.forename: D J
authors.identifier: 0000-0002-1829-4102
authors.initials: DJ
authors.lastname: Hartmann
authors.affiliation: Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
authors.forename: R
authors.identifier: 0000-0002-3757-7298
authors.initials: R
authors.lastname: Sivan-Hoffmann
authors.affiliation: Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Galilee Medical Center (R.S.-H.), Nahariya, Israel.
authors.forename: R
authors.identifier: 0000-0002-1520-2057
authors.initials: R
authors.lastname: Riva
authors.affiliation: CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France Serine Proteases and Pathophysiology of the Neurovascular Unit (P.E.L.), INSERM UMR-S U919, Caen, France.
authors.forename: P E
authors.identifier: 0000-0002-2536-6338
authors.initials: PE
authors.lastname: Labeyrie
authors.affiliation: CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France Service Pharmaceutique (G.A.), Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France.
authors.forename: G
authors.identifier: 0000-0002-0729-9549
authors.initials: G
authors.lastname: Aulagner
authors.affiliation: Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France Centre de Neurosciences Cognitives (F.T., B.G.), CNRS, UMR 5229, Lyon, France benjamin.gory@chu-lyon.fr.
authors.forename: B
authors.identifier: 0000-0001-8424-4464
authors.initials: B
authors.lastname: Gory
mesh_terms: D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D016896:Treatment Outcome