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., Competing Interests: Competing interests: JMD: Consulting fees: Medtronic, MicroVention, Imperative Care, Xenter, RapidPulse, Canon, Johnson & Johnson; Financial Interests: QAS.ai, Rist Neurovascular, Cerebrotech, Synchron, Hyperion; Honoraria: Medtronic; Support for attending meetings and/or travel: Medtronic; Patents planned, issued or pending: QAS.ai; Participation on a Data Safety Monitoring Board or Advisory Board: NIH NIHDS Strokenet; Stock or stock options: Synchron, Cerebrotech, QAS.ai, RIST. KVS: Consulting Fees: Boston Scientific, Canon Medical Systems USA, Inc, MicroVention, Medtronic, Stryker Neurovascular; Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational event: Canon Medical Systems USA Inc; Stock or stock options: Boston Scientific, Access Closure Inc, Niagara Gorge Medical. EIL: Consulting fees: Clarion, GLG Consulting, Guidepoint Global, Medtronic, StimMed, Mosaic; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Medtronic, Penumbra, MicroVention (now Terumo Neuro), Integra; Patents planned, issued, or pending: Ultrasonic Surgical Blade; Participation on a Data Safety Monitoring Board or Advisory Board: NeXtGen Biologics, Cognition Medical; Endostream Medical, IRRAS AB; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: CNS, ABNS, UBNS; Stock or stock options (shareholder or ownership interest): NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, StimMed, Three Rivers Medical, Q’Apel, Dendrite; Other financial or non-financial interests: Haniva Medical Technology (Chief Medical Officer); Medtronic (National PI: Steering Committees for SWIFT Prime and SWIFT Direct trials; SHIELD trial; Site PI: STRATIS Study – Sub I); Penumbra (National PI: THUNDER trial); MicroVention (now Terumo Neuro) (Site PI: CONFIDENCE Study). AHS: Financial Interest/Investor/Stock Options/Ownership: Adona Medical, Inc, Basecamp Vascular SAS, Bend IT Technologies, Ltd, BlinkTBI, Inc, Borvo Medical, Inc, CerebrovaKP, Code Zero Medical, Inc, Cognition Medical, Collavidence, Inc, Contego Medical, Inc, CVAID Ltd, E8, Inc, Endostream Medical, Ltd, FreeOx Biotech, SL, Galaxy Therapeutics, Inc, Hyperion Surgical, Inc, Imperative Care, Inc, InspireMD, Ltd, Instylla, Inc, IRRAS AB, Launch NY, Inc, Neurolutions, Inc, Neurovascular Diagnostics, Inc, NeXtGen Biologics, Peijia Medical, PerFlow Medical, Ltd, Physician X, LLC, Piraeus Medical, Inc, Prometheus Therapeutics, Inc, Q’Apel Medical, Inc, QAS.ai, Inc, Radical Catheter Technologies, Inc, Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc, Serenity Medical, Inc, Silk Road Medical, Sim & Cure, Spinnaker Medical, Inc, StimMed, LLC, Synchron, Inc, T.G. Medical, Inc, Tulavi Therapeutics, Inc, Vastrax, LLC, Viseon, Inc, Viz.ai, Whisper Medical, Inc, Willow Medtech, Inc; Consultant/Advisory Board: Asahi Intecc Co. Ltd, Canon Medical Systems USA, Inc, CerebrovaKP, Cerenovus, Contego Medical, Inc, Cordis, Endostream Medical, Ltd, FreeOx Biotech, SL, Hyperfine Operations, Inc, Imperative Care, InspireMD, Ltd, IRRAS AB, Medtronic, MicroVention (now Terumo Neuro), Minnetronix Neuro, Inc, Peijia Medical, Perflow Medical, Ltd, Piraeus Medical, Inc, Prometheus Therapeutics, Inc, Q’Apel Medical, Inc, Serenity Medical, Inc, Shockwave Medical, Inc, StimMed, LLC, Stryker Neurovascular, Synchron Australia Pty Ltd, T.G. Medical, Inc, Vastrax, LLC, Vesalio, Viz.ai, Inc, WL Gore. National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention (now Terumo Neuro) FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial; Patents: Patent No. US 11,464,528 B2, Date: October 11, 2022, CLOT RETRIEVAL SYSTEM FOR REMOVING OCCLUSIVE CLOT FROM A BLOOD VESSEL, Applicant and Assignee: Neuravi Limited (Galway), Role: Co-Inventor., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)