Combined Woven EndoBridge (WEB) Device and Flow-Diverting Stent Placement via Bilateral Transfemoral Access for the Treatment of an Anatomically Complex Aneurysm.

BACKGROUND: The Woven EndoBridge (WEB) device and flow diverter stents have emerged as novel interventional materials developed in recent years for the endovascular management of intracranial aneurysms. The treatment of intracranial aneurysms with complex anatomy, such as wide necks or involvement of critical branching vessels, remains a challenge for endovascular therapy. WEB and flow diverter stents offer 2 promising intrasaccular flow disruption techniques. This case demonstrates its successful combined use with a WEB device and flow-diverting stent through a bilateral femoral approach to achieve complete occlusion of intracranial aneurysm.

METHODS: A 28-year-old female patient presented with an unruptured basilar artery aneurysm. Diagnostic angiography revealed a posterior circulation aneurysms measuring about 10.5×11.1 mm with a wide neck and incorporation of critical branching vessels. The anatomic complexity precluded conventional coil embolization or standalone therapies. The procedure was performed under general anesthesia through bilateral transfemoral access. Through one access, the WEB device (W2-10×5 mm, MicroVention) was navigated into the aneurysm sac and successfully deployed under fluoroscopic guidance. Subsequently, through the contralateral access, a flow-diverting stent (Pipeline, 2.9×20 mm, EV3) was deployed across the right posterior cerebral artery, facilitating parent artery reconstruction while preserving incorporated branches. The bilateral approach enabled simultaneous device manipulation and enhanced operational stability.

RESULTS: Immediate post-procedure angiography showed contrast stagnation within the aneurysm and preserved flow in all parent and branch vessels. The patient was discharged without neurological deficits (modified Rankin Scale score 0) and remained asymptomatic at follow-up.

CONCLUSIONS: This case illustrates that the combination of the WEB device and a flow-diverting stent, utilizing a bilateral transfemoral approach, is a feasible and effective treatment strategy for anatomically complex intracranial aneurysms. This technique leverages the strengths of both intrasaccular flow disruption and endoluminal reconstruction, providing a robust option for aneurysms with challenging morphology.