Bailout Technique for Protrusion and Migration of Detached Woven EndoBridge Devices with Amplatz Goose Neck Microsnare.

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Tác giả: Akiko Hasebe, Tetsuya Hashimoto, Junpei Koge, Shoji Matsumoto, Jun Morioka, Ichiro Nakahara, Kenichiro Suyama, Takeya Suzuki, Jun Tanabe, Sadayoshi Watanabe

Ngôn ngữ: eng

Ký hiệu phân loại:

Thông tin xuất bản: Japan : Journal of neuroendovascular therapy , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 727948

 OBJECTIVE: The Woven EndoBridge (WEB
  MicroVention TERUMO, Tustin, CA, USA) is an intrasaccular flow disruptor developed for the treatment of wide-neck bifurcation aneurysms (WNBA). While its safety and satisfactory mid- to long-term treatment outcomes have been documented, there have also been reports of complications such as WEB protrusion and migration. We encountered 3 cases in which the WEB protruded or migrated to the parent vessel after deployment, necessitating retrieval. In this report, we address the technical tips for retrieval techniques and factors associated with these complications, including a literature review. CASE PRESENTATION: Of the 120 cases of our experience with WEB treatment for cerebral aneurysms for the period since January 2021, 3 required WEB retrievals. In 2 cases, significant WEB migration toward the parent vessel occurred while maneuvering the delivery microcatheter because of sticky detachment. In the remaining case, after detachment of the WEB, tilting occurred, leading to a strong protrusion into one of the branches, which prevented guiding the microcatheter for bailout stenting. In all cases, the proximal marker of the WEB was captured using an Amplatz Goose Neck Microsnare (Medtronic, Minneapolis, MN, USA) pulled back into the VIA catheter (the delivery catheter for the WEB
  MicroVention TERUMO), and further into an intermediate catheter positioned as close to the aneurysm as possible, enabling uneventful retrieval. CONCLUSION: None of the cases damaged the aneurysm or proximal parent vessel wall, and additional aneurysm occlusion treatment was performed. However, WEB protrusions and migration are rare. When retrieval is required, it is crucial to act swiftly owing to the risk of distal thrombosis from the lumen inside of the WEB. Therefore, recognizing Goose Neck Microsnare as a retrieval technique is valuable.
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