Seby John1, Ramon Navarro2, Syed Irteza Hussain3, Khalil Zahra4, Mohammed Samy Elhammady2. 1. Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. Electronic address: johns5@clevelandclinicabudhabi.ae. 2. Department of Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Neurosurgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 3. Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 4. Department of Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Neuroradiology, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Abstract
BACKGROUND: Intrasaccular flow disruption has emerged as a useful modality for treatment of wide-necked saccular aneurysm at vessel bifurcations. The Woven EndoBridge (WEB) device is one such device that has been evaluated in several series with excellent safety and good midterm efficacy. Bailout techniques to retrieve or reposition a dislocated WEB device are sparse and associated with significant risks. We describe a case of a dislocated WEB device that was repositioned with a microcatheter alone. METHODS: We describe a case of a WEB device that inadvertently detached in the parent vessel and the technique we used to reposition it. A number of bailout techniques are discussed with pros and cons associated with each maneuver. RESULTS: An unruptured middle cerebral artery (MCA) aneurysm was treated by endovascular embolization with a WEB device. The WEB was deployed within the aneurysm without incident. However, the device failed to detach. While attempting to resheath the device, it extruded out of the aneurysm and then inadvertently detached in the MCA. After many options were considered, a microcatheter alone was used to push the device back into the aneurysm. CONCLUSION: Caution should be exercised, especially when detaching the WEB device. Microcatheter repositioning by pushing the dislocated device may be attempted, especially if part of the device is within the aneurysm. This is the first description of the described microcatheter repositioning rescue maneuver.
BACKGROUND: Intrasaccular flow disruption has emerged as a useful modality for treatment of wide-necked saccular aneurysm at vessel bifurcations. The Woven EndoBridge (WEB) device is one such device that has been evaluated in several series with excellent safety and good midterm efficacy. Bailout techniques to retrieve or reposition a dislocated WEB device are sparse and associated with significant risks. We describe a case of a dislocated WEB device that was repositioned with a microcatheter alone. METHODS: We describe a case of a WEB device that inadvertently detached in the parent vessel and the technique we used to reposition it. A number of bailout techniques are discussed with pros and cons associated with each maneuver. RESULTS: An unruptured middle cerebral artery (MCA) aneurysm was treated by endovascular embolization with a WEB device. The WEB was deployed within the aneurysm without incident. However, the device failed to detach. While attempting to resheath the device, it extruded out of the aneurysm and then inadvertently detached in the MCA. After many options were considered, a microcatheter alone was used to push the device back into the aneurysm. CONCLUSION: Caution should be exercised, especially when detaching the WEB device. Microcatheter repositioning by pushing the dislocated device may be attempted, especially if part of the device is within the aneurysm. This is the first description of the described microcatheter repositioning rescue maneuver.
Authors: Andreas Simgen; Michael Kettner; Philipp Dietrich; Toshiki Tomori; Ruben Mühl-Benninghaus; Pervinder Bhogal; Matthias W Laschke; Michael D Menger; Wolfgang Reith; Umut Yilmaz Journal: Clin Neuroradiol Date: 2020-03-12 Impact factor: 3.649