{
  "abstract": "Background and Objectives The Woven EndoBridge (WEB) device is widely used for wide-neck bifurcation aneurysms but remains sensitive to aneurysm geometry, particularly in cases with a large parent vessel-to-dome axis (‘flow angle’) >45°, where suboptimal conformability and incomplete occlusion are more common. We evaluated a structured intra-aneurysmal maneuvering technique enabled by a novel width-weighted sizing method, which - based on calculated aneurysm dimensions - systematically selects wider WEB devices, promoting improved intra-aneurysmal ‘corking,’ stability, and controllability during deployment.Methods We retrospectively analyzed consecutive patients with intracranial aneurysms with flow angle >45°, treated with the WEB device between February 2019 and October 2024, with ≥12-month angiographic follow-up. Cases were included when procedural documentation confirmed use of both the width-weighted sizing strategy and a stepwise intra-aneurysmal maneuvering technique consisting of locking the partially flowered, wider and corked WEB, followed by forward pressure to tilt and centralize the device prior to final deployment. Clinical, geometric, and angiographic outcomes were assessed.Results Thirty-eight aneurysms (10 ruptured, 28 unruptured) were included. Technical success was achieved in 36/38 cases (94.7%), with one complication (2.6%). The width-weighted sizing approach enabled selection of wider devices that achieved stable intra-aneurysmal anchoring (‘corking’), facilitating controlled device tilting and centralization despite unfavorable angulation. Device compression was comparable to a reference cohort with flow angle <45° (41% vs 38%, p=0.39). At 12 months, adequate occlusion (WEB Occlusion Scale 0-1) was achieved in 33/38 aneurysms (86.8%).Conclusions A calculation-based width-weighted sizing strategy that favors wider WEB selection enables effective intra-aneurysmal maneuvering and controlled device positioning in highly angulated aneurysms. This combined approach may overcome geometric limitations and expand the applicability of WEB embolization while maintaining high occlusion rates.Disclosures O. Doron: None. J. Vranic: None. A. Patel: None.Abstract E-257 Figure 1Abstract E-257 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Chicago, Chicago, IL"
      ],
      "name": "O Doron"
    },
    {
      "affiliations": [
        "Neurosurgery, MGH, Boston, MA"
      ],
      "name": "J Vranic"
    },
    {
      "affiliations": [
        "Massachusetts General Hospital, Boston, MA"
      ],
      "name": "C Stapleton"
    },
    {
      "affiliations": [
        "Neurosurgery, Massachusetts General Hospital, Boston, MA"
      ],
      "name": "R Regenhardt"
    },
    {
      "affiliations": [
        "Neurosurgery, MGH, Boston, MA"
      ],
      "name": "A Patel"
    }
  ],
  "title": "E-257 Angling the WEB: width weighted upsizing enables controlled intra aneurysmal maneuvering and effective treatment of highly angulated aneurysms",
  "uid": "83cd9bbd-c8de-5898-8dfb-f28ec1b494cf"
}