Rescue techniques for intravascular mechanical obstruction following Woven EndoBridge (WEB) device detachment.

Abstract

The Woven EndoBridge (WEB) device is a well established treatment for bifurcation aneurysms.1-6 However, failed detachment after deployment can present significant challenges. In this technical video (video 1), we report on a patient with a left middle cerebral artery (MCA) bifurcation aneurysm treated with the WEB device. Despite satisfactory deployment, multiple detachment attempts were unsuccessful. After repeated maneuvers, the WEB was finally detached but slightly protruded from the aneurysm sac, compromising blood flow in the superior branch of the MCA. Even after placing an Atlas stent, blood flow was not restored. Ultimately, using a microguidewire and microcatheter, we repositioned the protruded WEB device back into the aneurysm sac, successfully restoring blood flow. This case illustrates that the Atlas stent provides limited support for the WEB device. In similar situations, gently repositioning the protruded WEB back into the aneurysm sac may be a remedial measure. neurintsurg;16/12/1215/V1F1V1Video 1Technical video demonstrating rescue techniques for managing intravascular mechanical obstruction following detachment of the WEB device.