Anterior Communicating Artery Aneurysm: Aneurysm Recurrence After Initial Coil Occlusion, Treated with a WEB Device

  • Werner Weber
  • Sebastian FischerEmail author
Living reference work entry


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.


Anterior communicating artery (AcomA) aneurysm Intrasaccular flow disruption Woven EndoBridge (WEB) Aneurysm reperfusion 


  1. Fiorella D, Molyneux A, Coon A, Szikora I, Saatci I, Baltacioglu F, Sultan A, Arthur A. WEB-IT study investigators. Demographic, procedural and 30-day safety results from the WEB intra-saccular therapy study (WEB-IT). J Neurointerv Surg. 2017;9(12):1191–6. Scholar
  2. Gawlitza M, Soize S, Januel AC, Mihalea C, Metaxas GE, Cognard C, Pierot L. Treatment of recurrent aneurysms using the woven EndoBridge (WEB): anatomical and clinical results. J Neurointerv Surg. 2017;10(7):629–633. pii: neurintsurg-2017-013287.
  3. Henkes H, Fischer S, Liebig T, Weber W, Reinartz J, Miloslavski E, Kühne D. Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery. 2006;58(2):224–32. discussion 224-232CrossRefGoogle Scholar
  4. Pierot L, Costalat V, Moret J, Szikora I, Klisch J, Herbreteau D, Holtmannspötter M, Weber W, Januel AC, Liebig T, Sychra V, Strasilla C, Cognard C, Bonafé A, Molyneux A, Byrne JV, Spelle L. Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study. J Neurosurg. 2016;124(5):1250–6. Scholar
  5. Pierot L, Gubucz I, Buhk JH, Holtmannspötter M, Herbreteau D, Stockx L, Spelle L, Berkefeld J, Januel AC, Molyneux A, Byrne JV, Fiehler J, Szikora I, Barreau X. Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 study. AJNR Am J Neuroradiol. 2017;38(6):1151–5. Scholar
  6. Popielski J, Berlis A, Weber W, Fischer S. Two-center experience in the endovascular treatment of ruptured and unruptured intracranial aneurysms using the WEB device: a retrospective analysis. AJNR Am J Neuroradiol. 2018;39(1):111–7. Scholar
  7. Takigawa T, Suzuki K, Sugiura Y, Suzuki R, Takano I, Shimizu N, Tanaka Y, Hyodo A. Thromboembolic events associated with single balloon-, double balloon-, and stent-assisted coil embolization of asymptomatic unruptured cerebral aneurysms: evaluation with diffusion-weighted MR imaging. Neuroradiology. 2014;56(12):1079–86. Scholar
  8. Ten Brinck MFM, de Vries J, Bartels RHMA, Grotenhuis JA, Boogaarts HD. NeuroForm atlas stent-assisted coiling: preliminary results. Neurosurgery. 2018. [Epub ahead of print]

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und NuklearmedizinUniversitätsklinikum BochumBochumGermany

Personalised recommendations