A264 Stent by me: the SAFE TEDDY BEAR approach to ISD embolization

<h3>Introduction</h3> Intrasaccular flow disruptors (ISDs), such as the Woven EndoBridge (WEB) and Artisse, have revolutionized the treatment of wide-neck intracranial aneurysms by enabling flow disruption within the sac without the need for stents or balloons. Optimal aneurysm occlusion is achieved when the ISD fully conforms to the aneurysm sac. However, device protrusion into the parent artery remains a potential risk, sometimes necessitating rescue stenting. <h3>Aim of study</h3> We describe a novel technique ‘SAFE TEDDY BEAR’ that improves the safety and efficacy of ISD implantation in wide-neck aneurysms by allowing immediate bailout stenting in cases of device protrusion. <h3>Method</h3> The SAFE TEDDY BEAR technique involves the introduction of a second microcatheter into the parent artery prior to ISD deployment. This ‘safety’ catheter allows for immediate stent implantation if significant ISD protrusion occurs. If the device remains fully intrasaccular, the second catheter is removed without use. Although this technique requires DAPT, it enables precise and complete ISD deployment while retaining the option of stenting without delay or additional access attempts. <h3>Results</h3> To date, this technique has been used in over a dozen cases with excellent technical success and angiographic outcomes. In most cases, no stenting was required; in a few, prompt stent deployment effectively managed protrusion without complications. <h3>Conclusion</h3> The SAFE TEDDY BEAR technique offers a pragmatic approach to optimize ISD-based aneurysm treatment. Although it limits the DAPT-free advantage of ISDs, it improves procedural safety and may guide future innovations toward more durable aneurysm occlusion with minimized antiplatelet requirements. <h3>Conflict of Interest</h3> No