The "make a flower bud and push at neck" technique: A safe and versatile technique for Woven EndoBridge treatment

Purpose: The safety and efficacy of Woven EndoBridge (WEB) treatment has been proven. However, only a few standard techniques for safe and versatile WEB deployment have been described in the literature. In this study, we introduce the "make a flower bud and push at neck" technique to achieve safety and versatility during WEB treatment, referred to simply as the "flower bud" technique.

Methods: Consecutive patients who underwent WEB treatment between January 2021 and October 2023 were included. We dichotomized the techniques of WEB deployment into two: the "flower bud" technique and the ordinary unsheath technique. Patient demographics, clinical characteristics of the aneurysms, and treatment results were compared between the two techniques to evaluate the safety and versatility of the "flower bud" technique.

Results: Of 100 aneurysms, 96 were eligible in the study. The "flower bud" technique was applied in 79 aneurysms (82.3 %), and the ordinary unsheath technique was applied in 17 aneurysms (17.7 %). The aneurysm location significantly differed between both techniques. The degree of parent artery-aneurysm (PA) angle and the proportion of the PA angle ≥ 45° were significantly higher in the "flower bud" technique than in the ordinary unsheath technique (P = 0.024 and P = 0.009, respectively). Effective angiographical results and low morbidity/mortality rate were similar in the techniques, although intraoperative rupture was experienced in one aneurysm treated using the ordinary unsheath technique.

Conclusion: The "make a flower bud and push at neck" technique could be safer and more versatile in treating cerebral aneurysms by WEB compared to the ordinary unsheath technique.