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Microsurgical Clipping of a Middle Cerebral Artery Aneurysm After Woven Endobridge Embolization Recurrence

医学 剪裁(形态学) 大脑中动脉 动脉瘤 栓塞 放射科 外科 内科学 缺血 语言学 哲学
作者
Ariadna Robledo,Thomas S. Frank,Sean O’Leary,Peter Kan
出处
期刊:World Neurosurgery [Elsevier]
卷期号:177: 78-78 被引量:1
标识
DOI:10.1016/j.wneu.2023.06.011
摘要

We present the case of a 67-year-old patient with a left middle cerebral artery (MCA) aneurysm treated with a Woven EndoBridge (WEB) device, who experienced neck recurrence after initial complete obliteration. The initial angiogram showed a wide-necked left MCA aneurysm that measured 8 × 7 mm with a 5-mm neck, treated with a WEB device. Post implantation, the initial follow-up angiogram showed complete obliteration. However, subsequent angiogram showed neck recurrence measuring 6.6 × 1.7 mm. The WEB device has become a popular alternative to traditional clipping and coiling procedures, with studies reporting successful treatment of 85%. However, concerns have been raised regarding the device's efficacy in achieving complete aneurysm obliteration, with a lower rate of complete aneurysm occlusion and a higher rate of recurrence compared with surgical clipping. The decision was made to retreat with clipping, and the surgery was successful in completely obliterating the aneurysm. The patient had no residual MCA aneurysm, with both M2 branches patent on postoperative angiogram. Literature review of retreatment options for WEB device failures highlights that the retreatment rate after WEB embolization is approximately 10%. For surgically accessible aneurysms, surgical clipping is an effective retreatment strategy after WEB failure given the compressibility of the device. Video 1 and our literature review provide valuable insights into a rare case of aneurysm recurrence after complete obliteration at initial follow-up after WEB embolization that was successfully treated with surgical clipping.1, 2, 3, 4, 5, 6, 7, 8
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