Tools and Techniques
WEB as a combined support and embolization device in a giant partially thrombosed donut-shaped aneurysm

https://doi.org/10.1016/j.jocn.2020.02.026Get rights and content

Highlights

  • The WEB device can be used as a combined support and embolization device in difficult-to-treat intracranial aneurysms.

  • The WEB device can be useful in selective cases where other catheterization strategies have failed.

  • The combination of WEB device, flow diverter and coiling can be an effective treatment option in complex intracranial aneurysms.

Abstract

Background

Giant partially thrombosed aneurysms are challenging lesions for which treatment can be difficult due to their unfavourable anatomical configuration and abnormal flow conditions.

Case description

The patient presented in this report suffered from a symptomatic giant partially thrombosed donut-shaped aneurysm of the left-sided supraophthalmic internal carotid artery. Due to the location and the size of the aneurysm, endovascular treatment was performed. Navigation of the microcatheter-microwire-system distal to the aneurysm for stent deployment was technically not possible due to limited support, caused by the large aneurysm. Therefore, a WEB device was placed in the distal leg of the donut-shaped aneurysm. Additionally to the occlusion of this part of the aneurysm, the WEB device enabled enough support to navigate the microcatheter-microwire-system distal to the aneurysm. After deployment of a flow-diverting stent, coiling of the aneurysm was performed. Follow-up angiography showed complete occlusion of the aneurysm. The patient suffered from severe headaches which were no longer present 6 months after treatment.

Conclusions

The WEB intraaneurysmal flow diverter can be effectively used as combined support and embolization device for the treatment of complex aneurysms in selective cases where other catheterization and embolization strategies have failed.

Introduction

Giant partially thrombosed aneurysms are challenging lesions where treatment must be considered because of their poor natural history and bad prognosis [1]. Endovascular blood flow exclusion has progressively gained importance and is now the first line treatment in most cases. Secure navigation and catheterization of target arteries, which is an essential prerequisite for endovascular treatment, is particularly challenging not only due to their unfavourable anatomical configuration but also to abnormal flow conditions which worsen the microcatheter and microwire navigation conditions.

Section snippets

Case presentation

A 49 years-old woman was diagnosed with a giant partially thrombosed aneurysm of the left-sided supraophthalmic internal carotid artery (ICA) when referred for a brain MRI for persisting headaches. Apart from the headaches, the patient was asymptomatic. The pre-interventional 3D rotational angiography permitted to further characterize the aneurysm, which showed a size of 27 × 21 × 10 mm and a donut shape due to a centrally located intraluminal thrombus (Fig. 1A–C). After multidisciplinary

Discussion

Super-selective catheterization of an aneurysm and the blood vessels adjacent to it can be challenging due to anatomical and blood flow related conditions. Its failure is one of the leading causes of unsuccessful endovascular procedures.

Donut-shaped aneurysms, which are characterized by organized intraluminal thrombus, are particularly challenging lesions due to not only to their unfavourable anatomical configuration but also due to abnormal intrasaccular blood flow conditions which in our case

Ethical approval statement

Written informed consent for publishing this case report was provided by the patient.

Declaration of Competing Interest

DFV has received travel support outside this work from MicroVention and Stryker GmbH & Co. KG. MB reports board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman. MAM has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman,

References (7)

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