Skip to main content
SpringerLink
Log in
Book cover

The Aneurysm Casebook pp 1–7Cite as

Anterior Communicating Artery Aneurysm: Multilobulated Aneurysm with SAH, Treatment with a Single WEB SL Device

  • Living reference work entry
  • First Online:

  • 103 Accesses

Abstract

A 58-year-old male patient presented with acute coma due to a subarachnoid hemorrhage (SAH) from a multilobulated aneurysm of the anterior communicating artery (AcomA), located at the bifurcation of a truncular left A1-variant (aplasia of the right A1 segment). Access was difficult due to severe elongation of the common and internal carotid artery (CCA, ICA). Therefore, a combination of Neuron MAX and an intermediate catheter was necessary. WEB was chosen in order to avoid the need for balloon or stent remodeling in the acute phase after SAH. This case illustrates several challenges: (1) using a combination of two flexible access catheters to overcome the elongation of both the CCA and ICA; (2) using rotational DSA with 3D reconstruction to better understand the anatomy of a multilobulated aneurysm and being able to use this information to implement a treatment option which had at first been rejected, namely, applying an intrasaccular flow disruptor; (3) and using the information derived from the 3D angiography to find a suitable working projection without needing direct visualization of the aneurysm neck. The effectiveness of the WEB is evident in this case since the aneurysm perfusion stopped completely even before the WEB had been detached. Using a single intrasaccular device to treat a complex saccular aneurysm by sizing it to the central compartment is the main topic of this report.

This is a preview of subscription content, log in via an institution.

References

  • Caroff J, Mihalea C, Dargento F, Neki H, Ikka L, Benachour N, Moret J, Spelle L. Woven Endobridge (WEB) device for endovascular treatment of ruptured intracranial wide-neck aneurysms: a single-center experience. Neuroradiology. 2014;56(9):755–61. https://doi.org/10.1007/s00234-014-1390-7.

    Article  PubMed  Google Scholar 

  • Gralla J, Rennie AT, Corkill RA, Lalloo ST, Molyneux A, Byrne JV, Kuker W. Abciximab for thrombolysis during intracranial aneurysm coiling. Neuroradiology. 2008;50(12):1041–7. https://doi.org/10.1007/s00234-008-0457-8.

    Article  PubMed  Google Scholar 

  • Henkes H, Fischer S, Weber W, Miloslavski E, Felber S, Brew S, Kuehne D. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery. 2004;54(2):268–80; discussion 280-5.

    Article  Google Scholar 

  • Kaspera W, Ładziński P, Larysz P, Hebda A, Ptaszkiewicz K, Kopera M, Larysz D. Morphological, hemodynamic, and clinical independent risk factors for anterior communicating artery aneurysms. Stroke. 2014;45(10):2906–11. https://doi.org/10.1161/STROKEAHA.114.006055.

    Article  PubMed  Google Scholar 

  • Lawson A, Molyneux A, Sellar R, Lamin S, Thomas A, Gholkar A, Patankar T. Safety results from the treatment of 109 cerebral aneurysms using the Woven EndoBridge technique: preliminary results in the United Kingdom. J Neurosurg. 2018;128(1):144–53. https://doi.org/10.3171/2016.9.JNS152849.

    Article  PubMed  Google Scholar 

  • Ries T, Buhk JH, Kucinski T, Goebell E, Grzyska U, Zeumer H, Fiehler J. Intravenous administration of acetylsalicylic acid during endovascular treatment of cerebral aneurysms reduces the rate of thromboembolic events. Stroke. 2006;37(7):1816–21.

    Article  CAS  Google Scholar 

  • UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26): 2474–82. https://doi.org/10.1056/NEJMoa1113260.

    Article  Google Scholar 

  • Van Rooij WJ, Peluso JP, Bechan RS, Sluzewski M. WEB treatment of ruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2016;37(9):1679–83. https://doi.org/10.3174/ajnr.A4811.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany

    Jan-Hendrik Buhk, Jens Fiehler & Maxim Bester

  2. Neuroradiology, UKE, Hamburg, Germany

    Jan-Hendrik Buhk, Jens Fiehler & Maxim Bester

Authors
  1. Jan-Hendrik Buhk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens Fiehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maxim Bester
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan-Hendrik Buhk .

Editor information

Editors and Affiliations

  1. Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany

    Hans Henkes

  2. Dept. Neurosurgery & Intervent. Neurorad, Clinica Sagrada Familia , Buenos Aires, Argentina

    Pedro Lylyk

  3. Department of Neurosurgery, Klinikum Stuttgart Department of Neurosurgery, Stuttgart, Baden-Württemberg, Germany

    Oliver Ganslandt

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Buhk, JH., Fiehler, J., Bester, M. (2018). Anterior Communicating Artery Aneurysm: Multilobulated Aneurysm with SAH, Treatment with a Single WEB SL Device. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_61-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-70267-4_61-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-70267-4

  • Online ISBN: 978-3-319-70267-4

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation