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Background WEB is the most used intrasaccular flow disruptor (IFD) for intracranial aneurysms, but rising use of Contour, Nautilus, Medina, Artisse/Luna, Trenza and Neqstent demand clarification for when to use one IFD over another. We primarily compared angiographic efficacy and safety outcomes across all IFDs. Secondarily, we performed subgroup regressions to identify patient and aneurysm subgroups—particularly for WEB and Contour—in which outcomes differ.Methods From 6,255 records, 144 studies were analysed. Random-effects meta-analysis of proportions (Freeman–Tukey) pooled final adequate occlusion, retreatment, and safety/clinical outcomes. Prespecified follow-up–adjusted meta-regression (Hartung–Knapp) assessed predictors of retreatment and final occlusion. PLOGIT sensitivity analysis used Benjamini–Hochberg (BH) adjustment. Additive geometry regression models included dome diameter and neck width to estimate independent effects. Quality was assessed using JBI questionnaires.Results WEB contributed 9,004 patients (9,224 aneurysms) and Contour 722 patients (738 aneurysms). Pooled final adequate occlusion was 87.12% for WEB and 88.59% for Contour, with retreatment rates of 5.74% and 3.27%. For the other IFDs, pooled final occlusion was 83.8% (Artisse/Luna), 85.06% (Medina), 94.78% (Nautilus), 87.37% (Trenza), and 89.08% (Neqstent), but estimates were based on smaller evidence bases and shorter follow-up. In WEB meta-regressions, larger dome diameter and neck-width predicted lower final occlusion (=−0.251, BH-p dome=0.018; =−0.546, BH-pneck=0.014) and higher retreatment (=0.263, BH-pdome=0.004; =0.303, BH-pneck=0.050). Additive WEB regressions showed neck width independently reduced final occlusion (β=−0.527, p=0.046), while dome size drove retreatment (β=0.363, p<0.001). For WEB, age trended positively with occlusion (β=0.064, p=0.132) and negatively with retreatment (β=−0.038, p=0.201). Ruptured proportion minimally affected WEB but negatively impacted Contour.Conclusions IFDs appear safe and effective treatment options, but only WEB and Contour have substantial evidence. WEB shows clearer follow-up–adjusted dependence on aneurysm geometry and may be more robust in ruptured and older populations. Longer, standardised head-to-head trials are needed to guide selection and complications.Disclosures A. Narayan: None. F. Mariajoseph: None. J. Moore: None. Y. Mathangasinghe: None.Abstract O-062 Table 1Contour vs WEB: follow-up–adjusted meta-regression (PLOGIT) for final occlusion and retreatment with BH-adjusted p-values