Clipping as re-treatment strategy after treatment of a cerebral aneurysm with the Woven EndoBridge embolization device: case report

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Recently, treatment of cerebral aneurysms with the Woven EndoBridge (WEB) device has become an established endovascular strategy. However, over time, neurosurgeons and neuroradiologists will be confronted with the challenge of how to treat aneurysm recanalization. The authors report the case of a 49-year-old woman who underwent re-treatment with clipping after the recanalization of a 4 × 3–mm anterior communicating artery aneurysm that had previously been treated using a 4 × 3 WEB device. In contrast to the authors’ prior experiences with clipping of previously coiled aneurysms, the WEB device was found to have a responsive softness during clip placement, and the aneurysm was more maneuverable. Moreover, evaluation with indocyanine green angiography was easy to perform because of the transparent mesh of the WEB device. No profound scarring or WEB protrusion was noted during surgery, making the procedure easier and less dangerous with regard to additional complications. The authors suggest that re-treatment via clipping should be considered in select cases of aneurysm recurrence after treatment with an intraaneurysmal flow diverter.

ABBREVIATIONS ACoA = anterior communicating artery; DSA = digital subtraction angiography; EVT = endovascular treatment; ICG = indocyanine green; WEB = Woven EndoBridge.

Article Information

Correspondence Gregor Durner: University of Ulm, Günzburg, Germany. gregor.durner@googlemail.com.

INCLUDE WHEN CITING Published online March 23, 2018; DOI: 10.3171/2017.10.JNS171528.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Digital subtraction angiogram of the left carotid artery showing signs of recanalization in the ACoA after primary treatment with a WEB device.

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    CT angiogram (left) and intraoperative photograph (right) of a recanalized ACoA. Little scarring and no signs of WEB device extrusion can be seen. Figure is available in color online only.

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    ICG angiogram (left) and intraoperative photograph (right) of the ACoA after re-treatment using a 7-mm clip, confirming aneurysm occlusion. Figure is available in color online only.

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