Presentation
Headache
Patient Data
An aneurysm of approximately 7mm is incidentally found in the right anterior cerebral artery.
A decision to treat this aneurysm endovascularly was proposed to the patient and he accepted.
The frontal and lateral run prior to embolization confirms the presence of the right anterior cerebral artery aneurysm. Its dome to neck ratio is 0.66. WEB, a flow disruption device, was put into place. (Magnified) Control run shows immediate intra-saccular stagnation and occlusion.
Patient experienced no complication during his hospital stay and was discharged a few days later.
12-months follow-up was done showing a very satisfying result. WEB itself is minimally compacted. The aneurysm is considered successfully treated.
An example of a 6 x 5mm WEB SL device (not used in this patient).
Case Discussion
Wide-neck aneurysms present a challenge in endovascular treatment. Multiple treatment options include balloon or stent-assisted coilings, flow diverters, and intra-saccular devices.
Balloon or stent-assisted coilings, though a viable option, presents higher complication risks and lower intra-procedural control in comparison to intra-saccular devices. In this case, due to the almost square aneurysm shape, wide neck, and a bifurcation location, a Woven EndoBridge (WEB) device was chosen due to its proven effectiveness and more experience at this institution (more than 8 years after the first trial). Slight compaction is sometimes seen on follow-up and especially more so over time, and is considered normal if it does in a dome to neck fashion, however, very few studies have been assessed this phenomenon.
Newer intra-saccular devices such as Contour have been released and are approved for use in some countries.
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