Quick Control – WEB for the acute treatment of a ruptured, irregular ACoA aneurysm

Fabian FLOTTMAN

Jens FIEHLER

Maxim BESTER

A 66-year-old woman with sudden behavioral changes and progressive decline in consciousness is diagnosed with a ruptured anterior communicating artery aneurysm. Discover how rapid WEB deployment offered an effective and safe treatment in this acute neurovascular emergency.

Case presentation

Female patient, 66 years old
Went to family physician with acute headache
After that, took a nap, subsequently presented behavioral changes, such as placing a banana in the oven.
Consciousness progressively deteriorated.
No relevant medical history. Smoker.
Vital parameters: RR 260/110 mmHg, O2 98%, Pulse 68 / min, RR lowered to 165/95 mmHg

Clinically, in the ER, the patient presented as somnolent and mute. Pupils were isocoric and sluggishly reactive to light. No command following. No lateralizing signs. Glasgow Coma Scale: 9.

Acute CT + CTA

Native CT revealed extensive subarachnoid hemorrhage, with marked blood accumulation in the perimesencephalic cisterns, particularly the pentagon cistern.

CT angiography showed an Acom aneurysm.

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 1

Treatment planning

Patient was transferred to our hospital.

Treatment strategy:

WEB device

Access:

Transfemoral
7F Sheath
Envoy 7F
Catalyst 5F
Via 17
Traxcess wire

DSA

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 2

Right CCA

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 3

Left ICA

3D-DSA

Aneurysm measurement

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 4

6 x 3.3 mm

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 5

4 x 3.1 mm

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 6

Probing of aneurysm

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 7

WEB 6x3 release

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 8

Test run shows immediate stasis

Final WEB position

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 9

Control at 6 months

Quick Control – WEB for the Acute Treatment of a Ruptured, Irregular ACoA Aneurysm - Figure 10

WEB is safe for treatment of acutely ruptured aneurysms.

References

van Rooij WJ, Peluso JP, Bechan RS, Sluzewski M. WEB Treatment of Ruptured Intracranial Aneurysms. AJNR Am J Neuroradiol. 2016 Sep;37(9):1679-83. doi: 10.3174/ajnr.A4811. Epub 2016 Apr 21. PMID: 27102307; PMCID: PMC7984684.
Youssef PP, Dornbos Iii D, Peterson J, et al. Woven EndoBridge (WEB) device in the treatment of ruptured aneurysms. J Neurointerv Surg. 2021;13(5):443-446. doi:10.1136/neurintsurg-2020-016405

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