WEB at the Terminus: precise, simple, effective

• A 52-year-old woman presented with headaches following a minor fall.
• A brain CT with contrast revealed an incidental, unruptured aneurysm at the right internal carotid artery (ICA) terminus. She had no family history of intracranial aneurysms or hemorrhage.

The DSA shows a saccular aneurysm with a regular shape at the ICA terminus, measuring 7 mm in maximal width, 6 mm neck width, and 9 mm depth.

Strategy

After multidisciplinary discussion, an endovascular approach with an intrasaccular device was selected:

• WEB 10 x 5 mm

The decision was based on the aneurysm’s wide neck and bifurcation anatomy, where an intrasaccular solution offered effective occlusion without the need for reconstructive techniques or dual antiplatelet therapy.

Treatment

• The procedure was performed under general anesthesia via a right femoral artery access, through a NeuronMax 0.088" 80 cm sheath.
• A FargoMax 115 intermediate catheter was placed in the right ICA.
• A VIA 33 microcatheter was advanced into the aneurysm sac over a Synchro Soft 0.014" microwire.

A 10 x 5mm WEB SL device was deployed within the aneurysm.

Before detachment, the WEB already showed significant contrast stagnation within the sac — a clear sign of early flow disruption.

3D-Rotational angiography with diluted contrast (20%) before and after detachment confirmed correct device placement and stability, without parent vessel compromise.

Final angiograms confirmed optimal WEB positioning, contrast stasis with parent vessel patency.

Follow-up – 6 months DSA

Conclusion

• This case demonstrates that WEB embolization is a safe and effective option for the treatment of wide-neck ICA terminus aneurysms: the device enabled precise placement, immediate contrast stasis, and vessel preservation, without the need for adjunctive techniques or prolonged antiplatelet therapy.
• Larger aneurysms with regular morphology and a favorable neck entry angle may represent good candidates for WEBs, especially when oversizing and optimal neck coverage can be achieved.
• Careful anatomical selection and precise deployment remain key to successful treatment outcomes.

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