Endovascular Treatment of a Bihemispheric Distal Anterior Cerebral Artery A4 Broad-Necked Bifurcation Aneurysm Using the Woven EndoBridge Device: A Case Report.
Source: PubMed, NCBI / U.S. National Library of Medicine
To describe the feasibility of Woven EndoBridge (WEB; Terumo Neuro, Aliso Viejo, CA, USA) treatment for an aneurysm at the distal anterior cerebral artery A4 bifurcation and to highlight technical considerations for achieving peripheral access. A 57-year-old woman was incidentally diagnosed with an unruptured distal anterior cerebral artery aneurysm during a brain MRI performed for evaluation of headache. DSA demonstrated a wide-neck aneurysm arising at the A4 bifurcation of a right-dominant bihemispheric distal anterior cerebral artery (neck width, 5.90 mm; dome, 6.53 × 7.76 mm [mean, 7.15 mm]; height, 6.82 mm). Given the broad neck configuration and the necessity of preserving both distal branches, intrasaccular flow disruption using a WEB device was considered appropriate. Advancement through the A1 segment was impeded by steep angulation at the internal carotid artery-A1 junction and a pronounced ledge effect. The buddy-wire technique was initially attempted to improve support and trackability, but was unsuccessful. Stable access to the A2 segment was achieved only after catheter reshaping without further use of the buddy wire. A WEB SL 8 × 3 mm device (Terumo Neuro) was deployed, achieving adequate neck coverage with a marked reduction in aneurysmal inflow while maintaining patency of both distal anterior cerebral artery branches. The procedure was completed without any procedure-related complications. Follow-up MRI/MRA at 1 month showed no evidence of residual
Abstract
To describe the feasibility of Woven EndoBridge (WEB; Terumo Neuro, Aliso Viejo, CA, USA) treatment for an aneurysm at the distal anterior cerebral artery A4 bifurcation and to highlight technical considerations for achieving peripheral access. A 57-year-old woman was incidentally diagnosed with an unruptured distal anterior cerebral artery aneurysm during a brain MRI performed for evaluation of headache. DSA demonstrated a wide-neck aneurysm arising at the A4 bifurcation of a right-dominant bihemispheric distal anterior cerebral artery (neck width, 5.90 mm; dome, 6.53 × 7.76 mm [mean, 7.15 mm]; height, 6.82 mm). Given the broad neck configuration and the necessity of preserving both distal branches, intrasaccular flow disruption using a WEB device was considered appropriate. Advancement through the A1 segment was impeded by steep angulation at the internal carotid artery-A1 junction and a pronounced ledge effect. The buddy-wire technique was initially attempted to improve support and trackability, but was unsuccessful. Stable access to the A2 segment was achieved only after catheter reshaping without further use of the buddy wire. A WEB SL 8 × 3 mm device (Terumo Neuro) was deployed, achieving adequate neck coverage with a marked reduction in aneurysmal inflow while maintaining patency of both distal anterior cerebral artery branches. The procedure was completed without any procedure-related complications. Follow-up MRI/MRA at 1 month showed no evidence of residual aneurysm filling and no branch-related complications. In selected distal anterior cerebral artery aneurysms where branch preservation is essential and parent-artery protrusion can be avoided, WEB treatment may be a useful endovascular option. This case illustrates the feasibility of WEB treatment of aneurysms at the anterior cerebral artery A4 bifurcation.