{
  "abstract": "Background Early literature on the Woven EndoBridge (WEB) device reported 80–90% adequate aneurysm occlusion but low complete occlusion (40–55%). It is uncertain whether residual or recurrent aneurysms require re-treatment to prevent future rupture.Objective To systematically review the literature to meta-analyze occlusion and complication rates after re-treatment of these aneurysms.Methods PubMed and EMBASE were queried for ‘re-treatment’ of ‘recurrent’ or ‘residual’ aneurysms treated with the WEB device. Studies reporting strategies and outcomes were included. Patient and aneurysm characteristics, outcomes, and complications were extracted. Meta-analyses were conducted on variables reported by three or more studies.Results We included 15 studies of 220 patients (220 aneurysms) with a mean age of 57.8 years (95% CI 55.1 to 60.7 years). At baseline, 42.8% (95% CI 35% to 51%) of aneurysms were ruptured, had a mean 8.6 mm dome (95% CI 7.3 to 10 mm) and a mean 5.2 mm neck (95% CI 4.7 to 5.7 mm), and 69.85% were at bifurcations (95% CI 47.63% to 85.51%). At mean 11.2 months' follow-up (95% CI 8 to 15.6 months), 75.9% (95% CI 66.1% to 83.5%) had residual dome filling, predominantly from incomplete occlusion in 84.7% of cases (95% CI 66.6% to 93.9%). Endovascular management was used in 82.5% (95% CI 72.6% to 89.3%) of recurrences, with stent-assisted or flow diverter-assisted coil embolization being used in 42.4% (95% CI 32.7% to 52.8%). Overall, complication rates were 8.9% (95% CI 4.9% to 15.6%) thromboembolic and 8% (95% CI 4.3% to 14.2%) device-related. Complete angiographic occlusion after re-treatment was achieved in 64.1% (95% CI 52.6% to 74.2%), of patients, with 15.2% (95% CI 8.8% to 24.9%) requiring additional re-treatment.Conclusion Our review reports excellent safety and modest occlusion outcomes with re-treatment of recurrent or residual aneurysms post-WEB embolization. Outcomes with observational management of residual or recurrent aneurysms are lacking, questioning the requirement for re-treatment. Endovascular strategies demonstrated excellent safety and additional re-treatment rates, highlighting their expanding role in post-WEB recurrences.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Vinay Jaikumar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Jaims Lim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Matthew D Moser"
    },
    {
      "affiliations": [
        "University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Bernard Okai"
    },
    {
      "affiliations": [
        "University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Hendrick Francois"
    },
    {
      "affiliations": [
        "Phasor Health, LLC, Houston, Texas, USA"
      ],
      "name": "Ana E Cadar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Muhammad Waqas"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Andre Monteiro"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Pui Man Rosalind Lai"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Department of Bioinformatics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA",
        "Jacobs Institute, Buffalo, New York, USA"
      ],
      "name": "Jason M Davies"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA",
        "Jacobs Institute, Buffalo, New York, USA"
      ],
      "name": "Kenneth V Snyder"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA",
        "Jacobs Institute, Buffalo, New York, USA",
        "Department of Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Elad I Levy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA",
        "Jacobs Institute, Buffalo, New York, USA",
        "Department of Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Adnan H Siddiqui"
    }
  ],
  "title": "Addressing residual and recurrent aneurysms post-Woven EndoBridge device embolization: a systematic review and meta-analysis",
  "uid": "8ef13aa0-fcd0-53a4-bb27-065a318cbd50"
}