Anterior Communicating Artery Aneurysm: SAH and Large Intracerebral Hematoma Due to a Ruptured Anterior Communicating Artery Aneurysm, Initially Treated with a WEB Device, and Re-treatment of a Residual Aneurysm with Stent-Assisted Coiling
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A 21-year-old female patient presented with spontaneous subarachnoid hemorrhage (SAH) and a large right frontal lobe intracerebral hematoma (ICH), graded Hunt and Hess IV and Fisher IV. The hemorrhage was caused by the rupture of an aneurysm of the anterior communicating artery (AcomA). The aneurysm was treated in the acute phase with the implantation of a single-layer spherical 7 mm WEB device, resulting in complete aneurysm occlusion with no complications. Follow-up DSA 6 months after implantation of the WEB device showed continued aneurysm perfusion. A second follow-up DSA was performed 11 months after SAH under general anesthesia. Re-treatment with stent-assisted recoiling was carried out without complications. Residual aneurysms after WEB device confer similar treatment possibilities as untreated aneurysm, including advanced endovascular treatment methods such as stent- and balloon-assisted coiling as well as the implantation of a flow diverter. The management of residual and recurrent aneurysms previously treated with a WEB device is the main topic of this chapter.
KeywordsAnterior communicating artery WEB device Stent-assisted coiling LVIS jr. stent Residual aneurysm
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