Stent-Assisted Woven EndoBridge Implantation for Treatment of Wide-Necked Aneurysm Residual: Angiographic Video

Woven EndoBridge (WEB) is an intrasaccular flow-disrupting device that has recently been approved by the U.S. Food and Drug Administration (FDA) for treatment of wide-neck ruptured and unruptured aneurysms at arterial bifurcations. Successful and effective treatment of aneurysms with the WEB device requires accurate sizing. For optimal positioning of the WEB device within the aneurysm sac, the diameter of the device has to exceed by the mean diameter of the aneurysm by 1.0 mm. However, this predictably results in an increase in the height of the device. In shallow, wide-necked aneurysms, this increase in height of the WEB device could result in encroachment of the device on the parent artery or branch vessel origins. In these circumstances, the placement of an intracranial stent can prevent such encroachment. In this video, we demonstrate the operative technique of stent-assisted WEB device placement that was performed at our institution for the treatment of a recurrent basilar apex aneurysm (Video 1). This previously ruptured aneurysm had been treated initially with primary coil embolization, and the patient consented to endovascular treatment of her aneurysm recurrence. The video illustrates this procedure using a combination of fluoroscopic images, fluoroscopic cines, and digital subtraction angiograms.