Post-Detachment Displacement of a Woven EndoBridge (WEB) Device Managed via Microcatheter Manipulation: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Unruptured left middle cerebral artery wide-neck bifurcation aneurysm with post-detachment Woven EndoBridge (WEB) device displacement (n=1). Intervention: Mechanical manipulation via microcatheter and microguidewire ('pushing technique') after WEB SL 5 × 3 mm deployment. Primary outcome: Successful reseating of the displaced WEB device and restoration of parent branch vessel flow without rescue stenting.

Q: What does this research mean for the field?

Microcatheter manipulation alone can successfully reseat a displaced post-detachment Woven EndoBridge (WEB) device and restore vessel patency without requiring rescue stenting. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kyoichi Seo; Yoji Kuramoto; Soichiro Abe; Shinichi Yoshimura

doi:10.5797/jnet.cr.2026-0107

January 1, 2026Journal of Neuroendovascular TherapyOpen Access

Post-Detachment Displacement of a Woven EndoBridge (WEB) Device Managed via Microcatheter Manipulation: A Case Report

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Key result

Microcatheter manipulation successfully reseats a displaced WEB device, restoring branch flow and avoiding rescue stenting.

n=1

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Why the study?

Post-detachment Woven EndoBridge displacement is typically managed with rescue stenting, which necessitates unplanned long-term dual antiplatelet therapy, motivating this report of an alternative bailout using microcatheter manipulation alone.

Does mechanical manipulation via a microguidewire and microcatheter ('pushing technique') restore parent vessel flow and reseat the device without requiring rescue stenting in a patient with post-detachment Woven EndoBridge displacement?

Key Points

To report a case of acute post-detachment Woven EndoBridge (WEB) device displacement successfully treated with microcatheter manipulation alone to avoid rescue stenting and long-term dual antiplatelet therapy.
A 42-year-old patient underwent endovascular treatment for a bifurcation aneurysm using a 5 × 3 mm WEB device selected via automated volumetric planning.
Following device detachment, withdrawal of an adjunctive microcatheter triggered vascular recoil, pivoting the device toward the orifice of an arterial trunk.
Operators executed a stepwise bailout strategy, attempting mechanical repositioning via a Leonis Mova microcatheter pushing technique before considering rescue stenting.
Microcatheter pushing successfully reseated the displaced device across the aneurysm neck, immediately restoring parent vessel patency.
The repositioned device achieved adequate wall-to-wall apposition and compression in a 90° rotated orientation.
The intervention eliminated the need for unplanned rescue stenting, avoiding thromboembolic risks and mandatory long-term dual antiplatelet therapy.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does mechanical manipulation via a microguidewire and microcatheter ('pushing technique') restore parent vessel flow and reseat the device without requiring rescue stenting in a patient with post-detachment Woven EndoBridge displacement?

P

Population

A 42-year-old male with an enlarging unruptured wide-neck left middle cerebral artery bifurcation aneurysm (4.50 mm dome, 4.17 mm neck) who experienced post-detachment WEB device displacement.

I

Intervention

Sequential mechanical manipulation ('pushing technique') using a curved CHIKAI Nexus 14 microguidewire followed by an unshaped Leonis Mova microcatheter to physically pivot and reseat the displaced Woven EndoBridge (WEB SL 5 x 3 mm) device back into the aneurysm sac, performed under preoperative dual antiplatelet therapy (aspirin 100 mg and prasugrel 3.75 mg daily) via a right radial approach.

O

Outcome

Restoration of flow in the M2 inferior trunk, stable intrasaccular device seating, complete branch preservation on final angiography, and avoidance of unplanned rescue stenting and long-term dual antiplatelet therapy.surrogate

This case demonstrates that post-detachment displacement of a Woven EndoBridge device during intracranial aneurysm embolization can be safely managed using a microcatheter 'pushing technique' to restore vessel patency, thereby avoiding rescue stenting and mandatory long-term dual antiplatelet therapy.

Limitations

Single case study design
Limited follow-up duration
Unestablished long-term efficacy and unknown risk of device compaction or recanalization for a WEB device seated in a 90° rotated position
Substantial procedural risks associated with the pushing technique, including aneurysm perforation, mechanical damage to the WEB mesh, thromboembolism, and inadvertent vessel occlusion
Applicability is heavily dependent on the degree of axis deviation between the parent artery and the protruded WEB device
Single case study
Limited follow-up
Long-term efficacy and risk of device compaction or recanalization for a WEB in a 90° rotated position have not been established

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Implication

Should not yet change bailout strategies for displaced WEB devices; leaves open the reliability of microcatheter pushing in larger series.

Abstract

OBJECTIVE: To report a case of post-detachment Woven EndoBridge (WEB) displacement successfully managed through microcatheter manipulation alone, avoiding unplanned stenting, which necessitates long-term dual antiplatelet therapy. CASE PRESENTATION: A 42-year-old male presented with an unruptured middle cerebral artery bifurcation aneurysm. Device sizing was planned using high-resolution 3D DSA and volumetric analysis on a Siemens ARTIS icono biplane (ARTIS icono VE20 software; Siemens Healthineers, Erlangen, Germany). A WEB SL 5 × 3 mm device (Terumo Neuro, Tustin, CA, USA) was deployed and detached. However, the subsequent withdrawal of an adjunctive microcatheter from a branch vessel caused vascular recoil, leading the detached WEB to rotate and protrude toward the branch orifice, compromising distal flow. Instead of rescue stenting, we performed a "pushing technique" using a Leonis Mova microcatheter (SB-Kawasumi Laboratories, Kanagawa, Japan). The device was successfully reseated within the aneurysm sac, albeit with a 90° rotation. Final angiography confirmed stable seating and excellent branch patency. The patient was discharged without neurological deficits on single antiplatelet therapy. CONCLUSION: Post-detachment WEB displacement can occur due to dynamic vascular shifts even with precise volumetric sizing. Microcatheter manipulation is a feasible alternative bailout option that preserves the low-profile advantages of the WEB device and avoids the risks associated with rescue stenting.

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Cite This Study

Seo et al. (2026) conducted a case report in Unruptured left middle cerebral artery wide-neck bifurcation aneurysm with post-detachment Woven EndoBridge (WEB) device displacement (n=1). Mechanical manipulation via microcatheter and microguidewire ('pushing technique') after WEB SL 5 × 3 mm deployment was evaluated on Successful reseating of the displaced WEB device and restoration of parent branch vessel flow without rescue stenting. Microcatheter manipulation via the 'pushing technique' successfully reseated a displaced WEB device (with a 90° rotation) and restored branch flow in 1 patient, avoiding unplanned rescue stenting.

synapsesocial.com/papers/6af0e999de503f3774140a24 https://doi.org/10.5797/jnet.cr.2026-0107

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Post-Detachment Displacement of a Woven EndoBridge (WEB) Device Managed via Microcatheter Manipulation: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Post-Detachment Displacement of a Woven EndoBridge (WEB) Device Managed via Microcatheter Manipulation: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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