The WEVO Technique: A Novel Dual-Device Endovascular Strategy for Non-Geometric Wide Neck Bifurcation Aneurysms.

Abstract

Purpose: Non-geometric wide-neck bifurcation aneurysms (WNBAs) present with treatment challenges of unfavorable neck morphology at bifurcation sites combined with irregular saccular geometry. While microsurgical clipping remains the traditional standard treatment, unsuitable candidates often require endovascular alternatives. We developed the WEVO technique, combining a volumetrically matched Woven EndoBridge (WEB) placement with a LVIS EVO braided stent deployment to achieve device stabilization and neck reconstruction with enhanced metal coverage.

Methods: We conducted a retrospective review of 21 patients treated for non-geometric WNBAs. Patient demographics, aneurysm characteristics, procedural parameters, and clinical outcomes were analyzed. The LVIS EVO stent was deployed using a "shouldering" technique to compress stent cells across the aneurysm neck. All patients received dual antiplatelet therapy. Aneurysm occlusion was assessed using the WEB Occlusion Scale (WOS) at 3 to 6 months and at 12 months.

Results: Median age was 71 (IQR: 64-76); 71% were female. All aneurysms were unruptured with median volume 81.4 mm³ (IQR: 46.0-147.1). Most common locations included middle cerebral artery (33%) and basilar artery (33%). Upper extremity arterial access was used in all cases. Immediate contrast stasis was achieved in all patients. One patient developed transient intra-procedural stent thrombus that resolved with intra-arterial tirofiban. No other complications occurred. At 3 to 6‑month follow-up (n = 16), adequate occlusion (WOS Grade A or AB) was achieved in 87%. At 12-month follow-up (n = 11), adequate occlusion was maintained in all patients.

Conclusion: The WEVO technique provides a safe and effective endovascular treatment option for non-geometric WNBAs by combining intrasaccular flow disruption with neck scaffolding and increased metal coverage.