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Background Wide-neck bifurcation and sidewall intracranial aneurysms have posed a difficulty to endovascular surgeons. Although coils can be used, herniation to the parent vessel is common, thus, stent assisted coiling emerged as a treatment option. In recent years, intrasaccular devices such as the Woven Endobridge Device has facilitated the treatment and proved effective on the long run to treat these kinds of aneurysms. Several other devices have emerged, however, their effectiveness has not been compared among them. This analysis could provide surgeons with a basis for clinical decision making.Methods We performed a systematic review in MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov from inception through February 10, 2026. Studies enrolling adults with wide-neck intracranial aneurysms treated with endovascular interventions were eligible. Comparative studies were included in our network meta-analyses when sufficient connectivity was present. Primary outcomes were immediate and last follow-up complete and adequate occlusion with a secondary analysis of post-operative complications.Results Thirty-two studies including 2,525 patients with 2,537 wide-neck intracranial aneurysms were included; 13 contributed to the network meta-analysis. Immediate complete occlusion was higher with coil-based strategies than with Woven EndoBridge (WEB) (primary coiling (PC) vs WEB: OR 3.46, 95% CI 1.43-8.34; stent-assisted coiling (SAC) vs WEB: OR 4.10, 95% CI 1.69-9.97), while Contour (CNT) showed lower immediate occlusion than both primary coiling (OR 0.10, 95% CI 0.01-0.71) and SAC (OR 0.08, 95% CI 0.01-0.60). At last follow-up, complete occlusion favored SAC over PC (OR 0.42, 95% CI 0.23-0.76). Thromboembolic events occurred in 6% of patients and were more frequent with SAC than with PC (OR 0.34, 95% CI 0.17-0.69) and WEB (OR 2.78, 95% CI 1.06-7.28).Conclusions Available evidence indicates that different endovascular treatments for wide-neck intracranial aneurysms each have advantages and disadvantages, with no single treatment clearly superior. Coil-based approaches, particularly stent-assisted coiling, were associated with higher rates of immediate angiographic occlusion, while stent-assisted coiling also showed improved complete occlusion at follow-up compared with primary coiling. However, these benefits were offset by a higher incidence of thromboembolic complications relative to primary coiling and intrasaccular treatment with WEB. Newer neck-bridging and intrasaccular devices show promising outcomes, but much of that evidence remains non-comparative and should not be interpreted as proof of superiority. Future in this field will require more standardized study design and reporting including aneurysm morphology, occlusion definitions, follow-up intervals, antiplatelet regimens, and retreatment criteria to enable more reliable cross-study comparisons and stronger comparative evidence.Disclosures J. Figueroa-Sanchez: None. H. Martinez: None. O. Gutierrez-Trevino: None. C. Armengol-Garcia: None. F. Luna-Rangel: None. J. Luna: None. B. Perez-Martinez: None.Abstract E-012 Figure 1