Woven EndoBridge Device immediate post-detachment tilt with later displacement: Case report, rescue techniques, and review of the literature

The Woven EndoBridge Device (WEB) is efficient and safe in the treatment of wide-neck bifurcation intracranial aneurysms. A crucial step in operative planning is establishing the appropriate dimension of the device, and there are limitations to the therapeutic solutions provided by WEBs. We describe a case of a right middle cerebral artery bifurcation wide-neck aneurysm treated with WEB. After the initial deployment of a WEB proven oversized, we substituted it with a smaller one that presented immediate post-detachment intra-aneurysmal tilt probably resulting from undersizing. The 24-h angiographic control identified a partial displacement of the device in the superior middle cerebral artery branch. We describe rescue techniques with review of the literature and our treatment strategy, including effort to reposition the device followed by stent deployment. The treatment was electively completed by the coil-through technique. The post-detachment WEB tilt should be considered an unstable position and treated either by removal of the device or with adjunctive implants. Each WEB size adapts to a range of aneurysmal height and width. This range is not always the same for each specific WEB dimension, based on the table provided by the manufacturer. This eventually predisposes to a different behavior of different WEB sizes regarding the modification of the device's height in relation to the modification of the diameter after deployment.