Microsurgical clipping versus Woven EndoBridge embolization for intracranial aneurysms: a systematic review and meta-analysis.
Ibrahim Alnaami, Abdallah Abbas, Haneen Sabet et al.
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In 30 seconds
This systematic review and meta-analysis compared microsurgical clipping with Woven EndoBridge (WEB) embolization for ruptured and unruptured intracranial aneurysms. It included five observational cohort studies comprising 798 patients. In good-quality concurrent studies, clipping was associated with higher angiographic occlusion (RR 1.30, 95% CI 1.14 to 1.49, I 2 0%). Morbidity and overall mortality did not differ significantly between techniques. The authors emphasize that these short-term angiographic results do not establish superior long-term durability, and that treatment comparisons are vulnerable to selection bias.
Key findings
- In good-quality concurrent studies, clipping was associated with higher occlusion than WEB embolization (RR 1.30, 95% CI 1.14 to 1.49, I 2 0%).
- Adequate or complete occlusion favored clipping (RR: 1.61, 95% CI: 1.24-2.11; P = 0.0004).
- No significant differences were observed in morbidity (RR: 0.86, 95% CI: 0.33-2.25) or overall mortality (RR: 0.69, 95% CI: 0.37-1.28).
- Adverse-event frequencies appeared broadly comparable, but inconsistent reporting prevented formal comparative analysis.
Why it matters
Angiographic occlusion is an important outcome when comparing aneurysm procedures, and the review suggests clipping may achieve higher short-term occlusion than WEB embolization. However, the absence of significant morbidity or mortality differences and the limited long-term recurrence and retreatment data mean that occlusion results alone cannot establish overall or durable superiority.
What to keep in mind
All included studies were observational and susceptible to selection bias. Adverse-event reporting was inconsistent, and limited long-term recurrence and retreatment data prevent conclusions about durability.