Modification of the Middle Cerebral Artery Bifurcation Angle Using a Stiff 0.014-Inch Microguidewire for Enhanced Woven EndoBridge Device Deployment

This report explores the challenges of using the Woven EndoBridge (WEB) (Terumo, Tokyo, Japan) for a middle cerebral artery bifurcation aneurysm and introduces a novel technical approach not previously described in the literature. In a 75-year-old male patient, a stiff microguidewire was used to guide a microcatheter to the distal branch of the middle cerebral artery bifurcation aneurysm to modify the bifurcation angle, ensuring the WEB's stable placement. The patient's postoperative course was uneventful, with magnetic resonance angiogram (MRA) confirming the aneurysm's complete disappearance. While the report suggests it as an approach that makes WEB insertion easier by altering the vascular route with only one stiff microwire, it highlights the need for more clinical cases to verify its effectiveness.