Withers James Russell, Dmytriw Adam A, Doron Omer, Stapleton Christopher J, Patel Aman B, Regenhardt Robert W
Department of Medicine, University of New England College of Osteopathic Medicine, Biddeford, United States.
Department of Neurosurgery and Interventional Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
Surg Neurol Int. 2025 Apr 11;16:128. doi: 10.25259/SNI_445_2024. eCollection 2025.
Coil embolization and surgical clipping are among the treatment options for acutely ruptured cerebral aneurysms. However, wide-neck aneurysms may necessitate stent placement, introducing dual antiplatelet therapy risks during subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB) intrasaccular device provides a unique solution for wide-neck aneurysms that does not require dual antiplatelet therapy.
This case report details a 56-year-old male with a recurrent basilar tip aneurysm, treated with three WEB devices. He presented with Hunt Hess grade 4 SAH and underwent initial embolization with a WEB 9 × 7.6 mm. He made a significant recovery, but recurrence of the aneurysm base was observed after 6 months. He underwent embolization with a second WEB 7 × 5.6 mm. A year later, follow-up angiography revealed a recurrence of the aneurysm base yet again, and he underwent embolization with a third WEB 5 × 3 mm.
This case demonstrates the application of the WEB for a ruptured aneurysm, obviating the need for dual antiplatelet therapy and minimizing the risks of re-rupture and extraventricular drain complications. It also demonstrates the technical feasibility of deploying three WEB devices in the same aneurysm, providing a strategy for challenging aneurysm recurrence. The WEB offers a safe approach for intrasaccular flow disruption with satisfactory occlusion rates for recurrent aneurysms.
弹簧圈栓塞和外科夹闭是急性破裂脑动脉瘤的治疗选择。然而，宽颈动脉瘤可能需要放置支架，这在蛛网膜下腔出血（SAH）期间会带来双重抗血小板治疗的风险。编织型血管内桥接器（WEB）囊内装置为宽颈动脉瘤提供了一种独特的解决方案，无需双重抗血小板治疗。
本病例报告详细介绍了一名56岁男性复发性基底动脉尖部动脉瘤患者，采用三个WEB装置进行治疗。他以Hunt Hess 4级SAH就诊，最初用一个9×7.6毫米的WEB进行栓塞。他恢复良好，但6个月后观察到动脉瘤基部复发。他接受了第二个7×5.6毫米的WEB栓塞治疗。一年后，随访血管造影显示动脉瘤基部再次复发，他接受了第三个5×3毫米的WEB栓塞治疗。
本病例展示了WEB在破裂动脉瘤治疗中的应用，避免了双重抗血小板治疗的需要，并将再破裂和脑室外引流并发症的风险降至最低。它还展示了在同一动脉瘤中部署三个WEB装置的技术可行性，为应对动脉瘤复发提供了一种策略。WEB为囊内血流阻断提供了一种安全的方法，对复发性动脉瘤具有令人满意的闭塞率。
