Anterior Communicating Artery Aneurysm: Multilobulated Aneurysm with SAH, Treatment with a Single WEB SL Device
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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.
KeywordsAcomA aneurysm Saccular aneurysm WEB Flow disruption 3D DSA
- 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. .
- 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. .
- 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.
- 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. .
- 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. .
- 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.
- 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. .
- Van Rooij WJ, Peluso JP, Bechan RS, Sluzewski M. WEB treatment of ruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2016;37(9):1679–83. .