LAUSR

BACKGROUND There is little information available regarding technical challenges with the new lower-profile Woven EndoBridge (WEB-17) system aimed for smaller aneurysms. METHODS We report illustrative cases of technical complications encountered with 2 anterior communicating artery aneurysms treated by WEB-17 system requiring rescue stenting in both cases. We discuss the cases, technical nuances regarding potential reasons for the encountered failures along with management plan for these situations. RESULTS Over a span of a year (January 2021- January 2022), 45 WEB embolization procedures were performed at both institutions. Out of those, two procedures were complicated by abrupt changing in orientation of the WEB device immediately following detachment from the delivery wire. In the first case, abrupt angulation with subsequent migration/prolapse out of the aneurysmal sac into the distal right anterior cerebral artery was encountered in one patient with unsuccessful retrieval despite multiple attempts utilizing variety of devices eventually requiring rescue stenting. Similar sudden orientation change was noted in the second case with partial prolapse from aneurysmal sac similarly bailed out by intracranial stenting. Both patients recovered to pre-procedural baseline with no permanent deficits and eventually were discharged home. CONCLUSION Intrasaccular WEB-17 embolization may be technically challenging in smaller wide-necked aneurysms with acute aneurysm-parent artery angulation with abrupt changing of the WEB device orientation after detachments with device migration/prolapse into the parent vessel requiring rescue stenting. Proper sizing of the WEB-17 device and vigilance to the transition phase between the end of deployment and detachment windows of the procedure are paramount to treatment success. Routine use of antiplatelets in the anticipatedly-challenging anatomical aneurysms might be a useful strategy if bailout stenting is needed.