Lateral Compression Manipulation: A Simple Approach for Sizing Taller-Than-Wide Intracranial Aneurysms with the Woven EndoBridge (WEB) Device

ABSTRACT

BACKGROUND AND PURPOSE:

The Woven EndoBridge (WEB) system (MicroVention in Tustin, CA, USA) has established itself as a safe and effective option for managing wide-necked bifurcation aneurysms. Addressing aneurysms with a greater height than width using conventional WEB sizing methods has proven ineffective due to the inherent configuration of the devices. To overcome this limitation, we propose an intuitive approach which involves swapping the width and height dimensions of the aneurysm to determine the appropriate WEB size.

MATERIALS AND METHODS:

A retrospective analysis was conducted on patients undergoing WEB embolization treatment at a single neuroscience center from March 2013 to February 2023.

RESULTS:

Twenty-five eligible aneurysms were identified, with the height dimension exceeding the width by an average of 2.33 mm (ranging from 1.4 to 4.5 mm). Out of these, twenty cases adhered to the recommended sizing technique, resulting in a 100% success rate of adequate occlusion (14/20 complete occlusion, 6/20 proximal recess filling). In contrast, the outcomes for the remaining five cases that did not follow the proposed sizing method were less favorable (p<0.05). Among these, four cases treated with undersized WEBs showed neck remnants during follow-up, and one patient who received an oversized WEB required device replacement during the same procedure.

CONCLUSIONS:

The simple sizing method we proposed for treating taller-than-wide aneurysms has demonstrated promising results, allowing the WEB system to address twice the original size range of treatable aneurysms. Further research with a larger sample size is recommended. ABBREVIATIONS: WEB = Woven EndoBridge; SL = Single Layer; SLS = Single Layer Sphere.