Wide-Necked Bifurcation Aneurysm: Treatment with Woven EndoBridge (WEB) Device
A 62-year-old female was diagnosed with an incidental wide-necked anterior communicating artery (ACOM) aneurysm with partial involvement at the neck of the right A2 vessel (Fig. 36.1a) on CTA. Sequential CT scans demonstrated interval growth and the patient requested treatment. Endovascular management options include balloon-assisted coiling, stent-assisted coiling, and treatment with WEB (Sequent Medical Palo Alto, CA, USA). The alternatives were evaluated in the neurovascular multidisciplinary team meeting, and WEB was decided upon. Two attempts at elective WEB embolization were unsuccessful due to difficult access with tortuous internal carotids (Fig. 36.1b) and an angulated ICA/A1 junction bilaterally (Fig. 36.1c). A third attempt was planned (Figs. 36.2 and 36.3).