Abstract
A 64-year-old woman was referred to our hospital with an incidental aneurysm of the right internal carotid artery (ICA) bifurcation. A Woven EndoBridge (WEB, MicroVention) device was used as an intrasaccular flow diverter for the treatment of this aneurysm. After the detached WEB later dislodged into the middle cerebral artery (MCA), an Alligator retrieval device (Medtronic) was used for the foreign body extraction. While cases of detachable coils dislodging into and subsequently necessitating removal from intracranial arteries have been sufficiently reported, the same is not true for the WEB. Intra-aneurysmal flow diverters offer an endovascular treatment option for broad-based intracranial aneurysms without having to place a neck-bridging device (e.g., self-expandable stent, remodeling balloon) in the parent artery. Experience with using the WEB as the only established intra-aneurysmal flow diverter is rapidly growing with promising angiographic and clinical results having been achieved over the past few years. Coil migration is a well-known complication in the endovascular treatment of intracranial aneurysms with standard coiling and occurs in up to 6% of cases. Several endovascular rescue strategies address this issue. Here, we describe a case of a secondary displaced WEB device during the treatment of an ICA aneurysm followed by successful withdrawal of the said WEB from the MCA with an Alligator (Medtronic). Removing a dislodged WEB is the main topic of this chapter.
This case report was previously published in the Springer journal Clinical Neuroradiology under open access: König I, Weber A, Weber W, Fischer S. Dislocation of a WEB device into the middle cerebral artery: removal with the Alligator Retrieval Device. Clin Neuroradiol. 2018 May 11. https://doi.org/10.1007/s00062-018-0685-1. [Epub ahead of print]
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Asnafi S, Rouchaud A, Pierot L, Brinjikji W, Murad MH, Kallmes DF. Efficacy and safety of the Woven EndoBridge (WEB) device for the treatment of intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2016;37(12):2287–92. https://doi.org/10.3174/ajnr.A4900.
Ding D, Liu KC. Management strategies for intraprocedural coil migration during endovascular treatment of intracranial aneurysms. J Neurointerv Surg. 2014;6(6):428–31. https://doi.org/10.1136/neurintsurg-2013-010872.
Henkes H, Lowens S, Preiss H, Reinartz J, Miloslavski E, Kühne D. A new device for endovascular coil retrieval from intracranial vessels: alligator retrieval device. AJNR Am J Neuroradiol. 2006;27(2):327–9.
Lawson A, Goddard T, Ross S, Tyagi A, Deniz K, Patankar T. Endovascular treatment of cerebral aneurysms using the Woven EndoBridge technique in a single center: preliminary results. J Neurosurg. 2017;126(1):17–28. https://doi.org/10.3171/2015.4.JNS142456.
Leslie-Mazwi TM, Heddier M, Nordmeyer H, Stauder M, Velasco A, Mosimann PJ, Chapot R. Stent retriever use for retrieval of displaced microcoils: a consecutive case series. AJNR Am J Neuroradiol. 2013;34(10):1996–9. https://doi.org/10.3174/ajnr.A3552.
Liu KC, Ding D, Starke RM, Geraghty SR, Jensen ME. Intraprocedural retrieval of migrated coils during endovascular aneurysm treatment with the Trevo Stentriever device. J Clin Neurosci. 2014;21(3):503–6. https://doi.org/10.1016/j.jocn.2013.10.012.
Lv X, Zhang Y, Jiang W. Systematic review of Woven EndoBridge for wide-necked bifurcation aneurysms: complications, adequate occlusion rate, morbidity, and mortality. World Neurosurg. 2018;110:20–5. https://doi.org/10.1016/j.wneu.2017.10.113.
Pierot L, Gubucz I, Buhk JH, Holtmannspötter M, Herbreteau D, Stockx L, Spelle L, Berkefeld J, Januel AC, Molyneux A, Byrne JV, Fiehler J, Szikora I, Barreau X. Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 study. AJNR Am J Neuroradiol. 2017;38(6):1151–5. https://doi.org/10.3174/ajnr.A5178.
Popielski J, Berlis A, Weber W, Fischer S. Two-center experience in the endovascular treatment of ruptured and unruptured intracranial aneurysms using the WEB device: a retrospective analysis. AJNR Am J Neuroradiol. 2018;39(1):111–7. https://doi.org/10.3174/ajnr.A5413.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
König, I., Weber, A., Weber, W., Fischer, S. (2020). Internal Carotid Artery Bifurcation Aneurysm: WEB Device Dislodging into the Middle Cerebral Artery Followed by Removal with an Alligator Retrieval Device and Subsequent Coiling of the Aneurysm. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-77827-3_70
Download citation
DOI: https://doi.org/10.1007/978-3-319-77827-3_70
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-77826-6
Online ISBN: 978-3-319-77827-3
eBook Packages: MedicineReference Module Medicine