Anterior Communicating Artery Aneurysm: Aneurysm Recurrence After Initial Coil Occlusion, Treated with a WEB Device
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This 64-year-old female patient experienced a spontaneous SAH in 2010 from a ruptured anterior communicating artery (AcomA) aneurysm that was treated by standard coil occlusion in the acute phase with rather loose packing of the coils at the neck region. Several MRI follow-up examinations revealed a progressive reperfusion of the said aneurysm, which was confirmed by conventional angiography in 2017. The broad-based oval aneurysm was treated with an intrasaccular flow disruptor, the Woven EndoBridge (WEB, MicroVention) device of the latest generation, meaning that this device can be deployed via a low-profile 0.017″ inner diameter microcatheter. The follow-up angiography of the clinically asymptomatic patient performed 3 months after the treatment revealed a complete occlusion of the aneurysm fundus with a reconstruction of the aneurysm neck. This case report illustrates the treatment strategy for wide-necked aneurysms by intrasaccular flow diversion. The main advantage of this technique is the possibility of treating complex or recurrent aneurysms without an implant inside the parent artery. This avoids the need for permanent antiplatelet medication. The appropriate sizing of the WEB device is crucial in order to achieve a stable aneurysm occlusion and is illustrated by both this case, and a further case is detailed in the discussion.
KeywordsAnterior communicating artery (AcomA) aneurysm Intrasaccular flow disruption Woven EndoBridge (WEB) Aneurysm reperfusion
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