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Middle Cerebral Artery Bifurcation Aneurysm: Wide-Necked Unruptured MCA Aneurysm Occlusion with Stent-Assisted WEB Implantation

  • Donald Lobsien
  • Joachim KlischEmail author
  • Christin Clajus
Living reference work entry

Abstract

We report on a 68-year-old female patient who was diagnosed with a complex incidental aneurysm on the bifurcation of the right-hand middle cerebral artery (MCA) alongside a small aneurysm on the superior MCA trunk. It was decided to treat the complex aneurysm with stent-assisted implantation of a Woven Endobridge (WEB, MicroVention) with a stent also covering the small aneurysm. During the treatment, two stents did not open, had to be removed, and due to a WEB-induced stenosis of the inferior trunk, this branch had to be stented as a bail-out strategy. Ultimately, the large MCA aneurysm was closed, and although the small aneurysm on the superior branch had to be left untreated, on follow-up it was discovered that this had also closed due to the anatomical changes caused by the way the WEB-stent-construct had altered the hemodynamics in that area. Stent-assisted WEB treatment of a complex MCA aneurysm is the main topic of this chapter.

Keywords

Middle cerebral artery Woven Endobridge, WEB MCA aneurysm Wide neck Solitaire stent LVIS jr. Bail-out strategy 

References

  1. Armoiry X, Turjman F, Hartmann DJ, Sivan-Hoffmann R, Riva R, Labeyrie PE, Aulagner G, Gory B. Endovascular treatment of intracranial aneurysms with the WEB device: a systematic review of clinical outcomes. AJNR Am J Neuroradiol. 2016;37(5):868–72.  https://doi.org/10.3174/ajnr.A4611.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. Bhogal P, AlMatter M, Bäzner H, Ganslandt O, Henkes H, Aguilar Pérez M. Flow diversion for the treatment of MCA bifurcation aneurysms-a single centre experience. Front Neurol. 2017;2(8):20.  https://doi.org/10.3389/fneur.2017.00020.CrossRefGoogle Scholar
  4. Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A, Maiuri F. Endovascular treatment of cerebral aneurysms using flow-diverter devices: a systematic review. Neuroradiol J. 2015;28(4):365–75.  https://doi.org/10.1177/1971400915602803.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Clajus C, Strasilla C, Fiebig T, Sychra V, Fiorella D, Klisch J. Initial and mid-term results from 108 consecutive patients with cerebral aneurysms treated with the WEB device. J Neurointerv Surg. 2017;9(4):411–7.  https://doi.org/10.1136/neurintsurg-2016-012276.CrossRefPubMedGoogle Scholar
  6. Gawlitza M, Januel AC, Tall P, Bonneville F, Cognard C. Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: a single-center series with special emphasis on covered cortical branches and perforating arteries. J Neurointerv Surg. 2016;8(5):481–7.  https://doi.org/10.1136/neurintsurg-2015-011682.CrossRefPubMedGoogle Scholar
  7. Gawlitza M, Soize S, Manceau PF, Pierot L. An update on intrasaccular flow disruption for the treatment of intracranial aneurysms. Expert Rev Med Devices. 2019;16(3):229–36.  https://doi.org/10.1080/17434440.2019.1584035.CrossRefPubMedGoogle Scholar
  8. Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, Henkes H, Biondi A. pCONus device for the endovascular treatment of wide-neck middle cerebral artery aneurysms. AJNR Am J Neuroradiol. 2015;36(9):1735–40.  https://doi.org/10.3174/ajnr.A4392.CrossRefPubMedGoogle Scholar
  9. Gupta M, Cheung VJ, Abraham P, Wali AR, Santiago-Dieppa DR, Gabel BC, Almansouri A, Pannell JS, Khalessi AA. Low-profile Visualized Intraluminal Support Junior device for the treatment of intracranial aneurysms. Cureus. 2017;9(2):e1037.  https://doi.org/10.7759/cureus.1037.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Henkes H, Weber W. The past, present and future of endovascular aneurysm treatment. Clin Neuroradiol. 2015;25(Suppl 2):317–24.  https://doi.org/10.1007/s00062-015-0403-1.CrossRefPubMedGoogle Scholar
  11. Jeong W, Han MH, Rhee K. The hemodynamic alterations induced by the vascular angular deformation in stent-assisted coiling of bifurcation aneurysms. Comput Biol Med. 2014;53:1–8.  https://doi.org/10.1016/j.compbiomed.2014.07.006.CrossRefPubMedGoogle Scholar
  12. Klisch J, Sychra V, Strasilla C, Liebig T, Fiorella D. The Woven EndoBridge cerebral aneurysm embolization device (WEB II): initial clinical experience. Neuroradiology. 2011;53(8):599–607.  https://doi.org/10.1007/s00234-011-0891-x.CrossRefPubMedGoogle Scholar
  13. Lescher S, du Mesnil de Rochemont R, Berkefeld J. Woven Endobridge (WEB) device for endovascular treatment of complex unruptured aneurysms-a single center experience. Neuroradiology. 2016;58(4):383–90.  https://doi.org/10.1007/s00234-016-1641-x.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. Martínez Moreno R, Bhogal P, Lenz-Habijan T, Bannewitz C, Siddiqui A, Lylyk P, Hannes R, Monstadt H, Henkes H. In vivo canine study of three different coatings applied to p64 flow-diverter stents: initial biocompatibility study. Eur Radiol Exp. 2019;3(1):3.  https://doi.org/10.1186/s41747-018-0084-z.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Mihalea C, Escalard S, Caroff J, Ikka L, Rouchaud A, Da Ros V, Pagiola I, Marenco de la Torre JJ, Yasuda T, Popa BV, Ples H, Benachour N, Ozanne A, Moret J, Spelle L. Balloon remodeling-assisted Woven EndoBridge technique: description and feasibility for complex bifurcation aneurysms. J Neurointerv Surg. 2019;11(4):386–9.  https://doi.org/10.1136/neurintsurg-2018-014104.CrossRefPubMedGoogle Scholar
  17. Nussbaum ES, Madison MT, Goddard JK, Lassig JP, Kallmes KM, Nussbaum LA. Microsurgical treatment of unruptured middle cerebral artery aneurysms: a large, contemporary experience. J Neurosurg. 2018;1:1–7.  https://doi.org/10.3171/2018.1.JNS172466.CrossRefGoogle Scholar
  18. Pierot L, Biondi A. Endovascular techniques for the management of wide-neck intracranial bifurcation aneurysms: a critical review of the literature. J Neuroradiol. 2016;43(3):167–75.  https://doi.org/10.1016/j.neurad.2016.02.001.CrossRefPubMedGoogle Scholar
  19. van Rooij SB, van Rooij WJ, Peluso JP, Sluzewski M. The Woven EndoBridge (WEB) as primary treatment for unruptured intracranial aneurysms. Interv Neuroradiol. 2018;24(5):475–81.  https://doi.org/10.1177/1591019918772174.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Donald Lobsien
    • 1
  • Joachim Klisch
    • 1
    Email author
  • Christin Clajus
    • 1
  1. 1.Institut für diagnostische und interventionelle Radiologie und NeuroradiologieHELIOS Klinikum ErfurtErfurtGermany

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