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Technical video
Rescue techniques for intravascular mechanical obstruction following Woven EndoBridge (WEB) device detachment
  1. Haoyu Zhu1,2,
  2. Yupeng Zhang2,
  3. Shikai Liang3,
  4. Chuhan Jiang1,2
    1. 1 Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
    2. 2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    3. 3 Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
    1. Correspondence to Dr Chuhan Jiang; jiangchuhan126{at}126.com; Dr Shikai Liang; liangshikai90{at}126.com

    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.

    Video 1 Technical video demonstrating rescue techniques for managing intravascular mechanical obstruction following detachment of the WEB device
    • Aneurysm
    • Angiography
    • Complication
    • Technique

    Data availability statement

    The data that support the findings of this study are available from the corresponding author on reasonable request.

    https://doi.org/10.1136/jnis-2024-022430

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      Data availability statement

      The data that support the findings of this study are available from the corresponding author on reasonable request.

      Footnotes

      • Contributors HZ, YZ, SL, and CJ participated in the surgery. HZ wrote the manuscript. CJ is the guarantor for this study.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

      • Provenance and peer review Not commissioned; externally peer reviewed.

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