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

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.