Abstract
A left middle cerebral artery (MCA) bifurcation aneurysm was diagnosed incidentally in a 56-year-old male patient. He was a current smoker and his medical history included arterial hypertension and epilepsy. The MRI revealed a an unruptured aneurysm with a maximum fundus diameter of 9 mm. Selective cerebral angiography confirmed the presence of a wide-necked aneurysm with a mean transverse diameter of 6.9 mm and a mean height of 5.1 mm; the neck width was 6.3 mm. The superior M2 trunk originated from the aneurysm neck. With this complex anatomy, the multidisciplinary team recommended endovascular treatment of the aneurysm with the WEB device. The procedure was performed with dual antiplatelet therapy (75 mg aspirin and 180 mg ticagrelor PO daily 2 days prior to the intervention). Immediately after placement of the WEB device, DSA showed complete occlusion of the aneurysm and normal blood flow in the superior M2 trunk. Postoperatively the patient received 75 mg aspirin PO for 6 weeks, and ticagrelor was discontinued. The patient was discharged 2 days after the intervention without any neurological symptoms. Follow-up cerebral angiography at 6 and 12 months after treatment confirmed the stable obliteration of the aneurysm without recurrence or reperfusion. The value of the WEB device in the endovascular treatment of wide-necked MCA bifurcation aneurysms is the main topic of this chapter.
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Nguyen, H.A., Soize, S., Gawlitza, M., Pierot, L. (2019). Middle Cerebral Artery Bifurcation Aneurysm: Wide-Necked Incidental Middle Cerebral Artery Bifurcation Aneurysm – Endovascular Treatment with a WEB Single-Layer Device. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_85-1
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