Angiographically Occult Perforator Ischemia Detected by Motor-Evoked Potential Monitoring during Woven EndoBridge Deployment: A Case Report.
4 affiliations
- 1Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan.
- 2Division of Clinical Engineering, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan.
- 3Department of Neurosurgery, Muroran City General Hospital, Muroran, Hokkaido, Japan.
- 4Department of Neurosurgery, Shin-Sapporo Neurosurgical Hospital, Sapporo, Hokkaido, Japan.
Abstract
Objective
To demonstrate that intraoperative motor-evoked potential (MEP) monitoring can detect angiographically occult perforator ischemia caused by intermediate catheter-induced luminal occupation and flow restriction during Woven EndoBridge (WEB; Terumo Neuro, Aliso Viejo, CA, USA) deployment, which would otherwise remain unrecognized.Case presentation
A woman in her 60s underwent WEB deployment for an unruptured left middle cerebral artery aneurysm under general anesthesia with intraoperative MEP monitoring using an optimized transcranial electrical stimulation protocol. Immediately prior to device deployment, MEP amplitudes abruptly disappeared in the right extremities. DSA showed preserved lenticulostriate artery opacification; however, the M1 segment was nearly completely occupied by the intermediate catheter. Catheter-induced perforator ischemia was suspected, and the catheter was promptly withdrawn to the cavernous internal carotid artery. MEP signals fully recovered within approximately 4 minutes, and WEB deployment was completed without further incident. Postoperative MRI revealed a small lacunar infarction in the lenticulostriate territory, but the patient was discharged without neurological deficits.Conclusion
Intermediate catheter-induced luminal occupation of the parent artery can cause angiographically occult perforator ischemia detectable only by functional monitoring. MEP monitoring may serve as a critical safeguard during WEB deployment and other neuroendovascular procedures involving large-bore intermediate catheters in perforator-rich arterial segments.
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BibTeX
@article{takahashi2026angiographically,
title = {{Angiographically Occult Perforator Ischemia Detected by Motor-Evoked Potential Monitoring during Woven EndoBridge Deployment: A Case Report.}},
author = {Yasuhiro Takahashi and Shoto Yamada and Yuki Gotoh and Ryohei Saito and Chie Kamada and Ayumu Yamaoka and Sangnyon Kim and Yukinori Akiyama and Nobuhiro Mikuni},
journal = {Journal of neuroendovascular therapy},
year = {2026},
month = oct,
doi = {10.5797/jnet.cr.2026-0111},
url = {https://europepmc.org/article/MED/42969007},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Angiographically Occult Perforator Ischemia Detected by Motor-Evoked Potential Monitoring during Woven EndoBridge Deployment: A Case Report.
AU - Yasuhiro Takahashi
AU - Shoto Yamada
AU - Yuki Gotoh
AU - Ryohei Saito
AU - Chie Kamada
AU - Ayumu Yamaoka
AU - Sangnyon Kim
AU - Yukinori Akiyama
AU - Nobuhiro Mikuni
PY - 2026
DA - 2026/10/28
JO - Journal of neuroendovascular therapy
DO - 10.5797/jnet.cr.2026-0111
UR - https://europepmc.org/article/MED/42969007
AB - Objective To demonstrate that intraoperative motor-evoked potential (MEP) monitoring can detect angiographically occult perforator ischemia caused by intermediate catheter-induced luminal occupation and flow restriction during Woven EndoBridge (WEB; Terumo Neuro, Aliso Viejo, CA, USA) deployment, which would otherwise remain unrecognized.Case presentation A woman in her 60s underwent WEB deployment for an unruptured left middle cerebral artery aneurysm under general anesthesia with intraoperative MEP monitoring using an optimized transcranial electrical stimulation protocol. Immediately prior to device deployment, MEP amplitudes abruptly disappeared in the right extremities. DSA showed preserved lenticulostriate artery opacification; however, the M1 segment was nearly completely occupied by the intermediate catheter. Catheter-induced perforator ischemia was suspected, and the catheter was promptly withdrawn to the cavernous internal carotid artery. MEP signals fully recovered within approximately 4 minutes, and WEB deployment was completed without further incident. Postoperative MRI revealed a small lacunar infarction in the lenticulostriate territory, but the patient was discharged without neurological deficits.Conclusion Intermediate catheter-induced luminal occupation of the parent artery can cause angiographically occult perforator ischemia detectable only by functional monitoring. MEP monitoring may serve as a critical safeguard during WEB deployment and other neuroendovascular procedures involving large-bore intermediate catheters in perforator-rich arterial segments.
SN - 1882-4072
SN - 2186-2494
ER -