WovenEndoBridge-assisted coiling: Step-by-step technical insights

Abstract

Treating ruptured wide-necked bifurcation aneurysms (WNBAs) presents challenges.¹ The WovenEndoBridge (WEB, Microvention) device is often utilized for WNBAs but is typically inadequate for large (≥10 mm) aneurysms.^2,
3 The WEB-assisted coiling technique may enable the use of the WEB device as an adjunct in coiling large WNBAs, particularly when the very wide neck precludes remodeling techniques.^4,
5 Understanding of this technique is derived from a limited number of cases, with scant comprehensive technical insights available.^4,
5 The technical video (online supplemental material) demonstrates the WEB-assisted coiling technique for treating a ruptured large basilar tip aneurysm (height: 14.6 mm; width: 10 mm; neck: 6.8 mm) in a 53-year-old male patient. Steps include (1) catheterization of the aneurysm sac with a coil microcatheter and a Via catheter for WEB deployment; (2) jailing the coil microcatheter and deploying the WEB to act as a cork against the aneurysm neck; (3) coiling the residual aneurysm dome, followed by removal of the coil catheter and detachment of the WEB. This technique has the potential to simplify the treatment of ruptured large WNBAs in the acute setting without using neck remodeling and anti-aggregation. Subsequently, it may allow the physician to manage the case electively under dual anti-aggregation with stenting, as described here and by Simgen et al.⁵

Keywords

WovenEndoBridge coiling assisted-coiling aneurysm

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References

Pierot

Spelle

Cognard

, et al.

Wide neck bifurcation aneurysms: what is the optimal endovascular treatment?

J Neurointerv Surg 2021; 13: e9.

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, et al. How to WEB: a practical review of methodology for the use of the Woven EndoBridge. J Neurointerv Surg 2020; 12: 512–520.

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Molyneux

Coon

, et al. Safety and effectiveness of the WovenEndoBridge (WEB) system for the treatment of wide necked bifurcation aneurysms: final 5 year results of the pivotal WEB intra-saccular therapy study (WEB-IT). J Neurointerv Surg 2023; 15: 1175–1180. Published online June 24, 2023.

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Chavda

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. Republished: corking the WEB and coiling through a jailed microcatheter: WEB assisted coiling, a useful technique avoiding the use of stents in treating wide-necked large intracranial aneurysms. J Neurointerv Surg 2016; 8: e18–e18.

Simgen

Antes

Dietrich

, et al. WovenEndoBridge device (WEB)-assisted coiling of a large MCA-aneurysm: case report and technical note. Interdiscip Neurosurg 2023; 33: 101785.

Supplementary Material

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