P-051 Treatment of acutely ruptured intracranial aneurysms with woven endobridge device: a systematic review

Introduction The Woven Endobridge (WEB) device is a barrel-shaped nitinol mesh deployed within the aneurysmal sac. The absence of metallic mesh in the vessel lumen obviates the need for potent antiplatelet therapy, which makes this devices interesting for acutely ruptured aneurysms not amenable to clipping or coiling. Methods We performed a comprehensive systematic search of Pubmed, MEDLINE and EMBASE databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords combined with Boolean operators to increase search sensitivity and specificity (‘woven endobridge device’ AND ‘ruptured’) were used. Results Five studies were included, totalizing 276 ruptured aneurysms. Overall, 222 (80.4%) were wide-neck and 236 (85.5%) were located in the anterior circulation. Grade of SAH based on Hunt and Hess scale was reported in four studies with 64 (25.7%) of patients presenting with a poor grade (Hunt and Hess 4-5). Intraoperative and post-operative complications occurred in 7.2% (95% CI, 3.8-13.4) and 4.3% (95% CI, 1.9-9.2) respectively. The rate of rebleeding after treatment was 0%. The rates of adequate occlusion and retreatment at last follow-up were 86.5% (95% CI, 75.6-93) and 5.9% (95% CI, 3.2-10.6), respectively. The rate of favorable outcome was 71% (95% CI, 64-77) and mortality was 19.4% (95% CI, 14.3-25.7). The United-States multicenter study reported use of intraoperative single-antiplatelet therapy (SAPT) in 13.1% and dual-antiplatelet therapy (DAPT) in 2.2%, while 18.7% were discharged under DAPT. The remaining 4 European studies reported no use of antiplatelets during the procedure unless stenting was needed. Two studies reported no use of antiplatelet regimen during follow-up, while 2 studies reported use of SAPT for 4-6 weeks. Conclusions Treatment of acutely ruptured aneurysms with WEB device results in high rates of adequate occlusion, with low perioperative complications, no rebleeding and low recurrence. This device is promising for wide-necked ruptured aneurysms that are not amenable to clipping or coiling, considering its lower need for antiplatelet regimen either during procedure or follow-up. Disclosures A. Monteiro: None. A. Lazar: None. M. Waqas: None. H. Rai: None. A. Baig: None. R. Dossani: None. F. Almayman: None. J. Cappuzzo: None. J. Davies: 1; C; National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001413 to the University at Buffalo. K. Snyder: 2; C; Canon Medical Systems Corporation, Penumbra Inc., Medtronic, and Jacobs Institute. E. Levy: 2; C; Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound, StimMed;. 4; C; NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care (formerly the Stroke Project), Rebound Therapeutics, StimMed, Three Rivers Medical;. A. Siddiqui: 2; C; Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc., Cerebrotech Medical Systems Inc., Cerenovus, Corindus Inc., Endostream Medical Ltd., Imperative Care, Inc. Integra LifeSciences C. 4; C; Adona Medical, Inc, Amnis Therapeutics, (Purchased by Boston Scientific October 2017), Blink TBI Inc., Buffalo Technology Partners Inc., Cerebrotech Medical Systems, Inc., Cognition Medical, Endostrea.