ArticleJournal of neurosurgery. Case lessons2026
Intermediate catheter-assisted "putting down your foot" technique: Woven EndoBridge embolization of basilar tip aneurysm. Illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe Woven EndoBridge (WEB) device is commonly used for wide-neck bifurcation aneurysms, but deployment can be challenging in unfavorable anatomy, with risks of protrusion or malposition. The authors describe a novel intermediate catheter-assisted "putting down your foot" technique, used to reposition a protruding WEB device in a basilar tip aneurysm. OBSERVATIONS: A 57-year-old man with an incidental 7-mm basilar tip aneurysm underwent embolization with a 8 × 3-mm WEB SL device. During deployment, the WEB device developed a butterfly configuration with repeated protrusion into both posterior cerebral arteries, resulting in > 50% parent-vessel encroachment despite standard corrective maneuvers. An 8 × 2-mm device was unavailable, and a 7 × 3-mm WEB device would not have provided adequate lateral compression. The WEB device was therefore recompressed using the delivery wire and microcatheter, while a Vecta 46 intermediate catheter was advanced to the aneurysm neck for countersupport. This maneuver enabled controlled reexpansion and accurate repositioning. Final angiography demonstrated optimal apposition (WEB Occlusion Scale grade B) and stable device positioning after detachment. LESSONS: Intermediate catheter-assisted support can safely aid WEB positioning during difficult deployments with protrusion or deformation, although further experience with the technique is required to define its reproducibility and role among bailout techniques. https://thejns.org/doi/10.3171/CASE25945.
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