Abstract Details

Title Treatment of a Wide Neck Middle Cerebral Artery Aneurysm with Secondary Lobule Using Combination Woven EndoBridge and Coil Embolization

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-010

Objective We present a case of a right middle cerebral artery bifurcation aneurysm treated by a WEB device and coil embolization

Background Middle cerebral artery bifurcation aneurysms have been historically challenging to treat endovascularly given they often have complex morphology and wide necks. The Woven EndoBridge (WEB) is an ellipsoid braided-wire embolization device designed to provide intrasaccular flow disruption along the aneurysm neck, which has been proven to be an effective method in treating a wide spectrum of wide-necked bifurcation aneurysms. Irregularities and secondary lobules at the base of the primary aneurysm can have persistent filling despite treatment

Design/Methods

48-year-old female active smoker without significant other medical history presented with sudden onset of the worst headache of her life followed by brief loss of consciousness. She presented 2 weeks after due to persistent headache and falls but neurologic examination was intact. CT head showed acute to subacute right MCA infarction with small volume subarachnoid hemorrhage. CTA head revealed a right MCA bifurcation irregular aneurysm. Diagnostic subtraction angiography confirmed irregular right MCA bifurcation aneurysm measuring 4.3 x 4.5 x 5.7 mm. Embolization was performed with WEB SL 6 x 4 mm device. Post-deployment angiograph showed occlusion of the aneurysm dome but persistent filling of secondary lobule near the base of the aneurysm. Given this residual lobule filling, additional embolization with a HyerSoft 3D 2mm x 2cm coil was performed with resulting good occlusion of the aneurysm. She was discharged home 5 days after admission ambulating independently

Results NA

Conclusions Many MCA bifurcation aneurysms can be treated minimally invasively, but there are some limitations to the WEB since every aneurysm is different and there are a finite number of sizes and shapes available for WEB. This case illustrates that adjunctive coil embolization can successfully treat a residual secondary base lobule after WEB embolization

Authors/Disclosures
Ali A. Alsarah, MD (University of New Mexico Hospital- Department of Neurology) PRESENTER	Dr. Alsarah has nothing to disclose.
Rashid A. Ahmed, MD (Upstate University Hospital)	Dr. Ahmed has nothing to disclose.
Adam Dmytriw (Massachusetts General Hospital)	Adam Dmytriw has nothing to disclose.
Omer Doron	No disclosure on file
Christopher Stapleton (Massachusetts General Hospital)	Christopher Stapleton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Johnson & Johnson MedTech. Christopher Stapleton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll Circulation, Inc.. Christopher Stapleton has received publishing royalties from a publication relating to health care.
William Smith	No disclosure on file
Robert W. Regenhardt, MD, PhD	Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genomadix. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. Dr. Regenhardt has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Buckley, Theroux, Kline, & Cooley Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
Aman Patel	Aman Patel has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Microvention. Aman Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Aman Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Penumbra.

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