Neurointervention.  2023 Jul;18(2):129-134. 10.5469/neuroint.2023.00136.

Woven EndoBridge Device Migration and Microsnare Retrieval Strategy: Single Institutional Case Reports with Technical Video Demonstration

• Santhumayor BA
• White TG
• Werner C
• Shah K
• Woo HH

• KMID: 2543368
• DOI: http://doi.org/10.5469/neuroint.2023.00136

Abstract

The Woven EndoBridge (WEB) (MicroVention/Terumo) device is a treatment option for wideneck bifurcation aneurysms. An uncommon adverse effect is WEB device migration. While certain bailout strategies for WEB recovery have been described, there is still a paucity of information on optimal strategies to maximize both short and long-term post-operative outcomes. We add 2 cases at our institution to the existing literature of WEBectomy in the setting of complicated intracranial aneurysm treatment. We discuss the long-term imaging outcomes with additional fluoroscopy video demonstrating our technique. Our findings reflect a clear benefit for the use of the Amplatz Gooseneck^TM microsnare (Medtronic) device as a means of WEB recovery, coupled with potential stent-assisted WEB embolization to remove the aneurysm from the parent circulation, while minimizing recurrence and thromboembolic complications.

Keyword

Cerebral aneurysm; WEB; Woven endobridge; Microsnare

Figure

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  Fig. 1. Woven EndoBridge (WEB; MicroVention/Terumo) migration and retrieval from the basilar artery (case 1). (A) Pre-embolization right vertebral artery angiogram. (B) Pre-detachment of WEB device in position within the basilar tip aneurysm. (C) Post-detachment of the WEB device right vertebral artery angiogram displaying device migration inferiorly into the basilar artery. (D) Post-coiling right vertebral artery angiogram.

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  Fig. 2. Woven EndoBridge (WEB) (MicroVention/Terumo) migration from anterior communicating aneurysm (case 2). (A) Pre-embolization left internal carotid artery angiogram. (B) Pre-detachment of WEB device after deployment of the WEB with positioning using the Scepter XC balloon. Arrows marking the distal balloon marker (black arrow) as well as the proximal marker of the WEB (white arrow). (C) Unsubtracted view post-detachment of the WEB device displaying device migration into the left anterior cerebral artery (ACA) with an arrow identifying the WEB. (D) Lateral carotid angiogram with arrow demonstrating ACA occlusion after migration of the WEB. (E) Unsubtracted lateral carotid angiogram demonstrating partial unsheathing of the first LVIS Jr. in an attempt for WEB retrieval. Resolution of vessel occlusion after partial unsheathing of the LVIS Jr. Arrows marking the body of the WEB device (white arrow) and the proximal stent (black arrow). (F) Roadmap view after bilateral internal artery injection with the microsnare in place with plans to capture the distal device marker. Arrow pointing to the microsnare with the loop about to grab the distal WEB marker. (G) Post-procedure left internal carotid angiography, frontolateral view, demonstrating decreased aneurysm filling. (H) Post-procedure micro dyna computed tomography demonstrating LVIS Jr. X stenting with placement of the WEB device in the aneurysm.

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