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Case Reports
. 2013 Dec;26(6):669-77.
doi: 10.1177/197140091302600610. Epub 2013 Dec 18.

Treatment of wide-neck basilar tip aneurysms using the Web II device

Ruben Colla  1 , Luigi Cirillo, Ciro Princiotta, Massimo Dall'olio, Federico Menetti, Stefano Vallone, Marco Leonardi
Affiliations
Case Reports

Treatment of wide-neck basilar tip aneurysms using the Web II device

Ruben Colla et al. Neuroradiol J. 2013 Dec.

Abstract

Endovascular treatment has assumed a major role in the management of intracranial aneurysms. Although current techniques have proven extremely effective in the embolization of a large number of intracranial aneurysms, wide-necked basilar tip aneurysms represent a subset that continues to pose technical challenges in treatment. This study reports our experience with WEB II, a new embolization device employed in four patients with this type of aneurysm.

Keywords: Woven EndoBridge II (WEB II); basilar tip; endovascular treatment; intracranial aneurysm.

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Figures

Figure 1
Figure 1
A) DSA showing a slightly irregularly shaped basilar tip wide-necked aneurysm. Both posterior cerebral arteries originate in proximity of the aneurysm neck, thus discouraging the use of coils and intraluminal flow diverters. B) DSA performed 2.5 hours after WEB II deployment. The aneurysm lumen is occluded and the WEB II device appears correctly positioned within the aneurysm. No sign of occlusion of both posterior cerebral arteries can be observed. C) Follow-up DSA performed 6 months after treatment shows a small bulging located at the tip of the basilar artery.
Figure 2
Figure 2
Wide-necked basilar tip aneurysm. B) Marked blood flow stagnation can be observed within the aneurysm sac 6 minutes after WEB II deployment. C) CTA performed 9 months after treatment shows the WEB II correctly positioned within the aneurysm sac (note the 3 radio-opaque markers aligned with the aneurysm neck and the silhouette of the WEB II itself). Both posterior cerebral arteries appear patent.
Figure 3
Figure 3
A) Wide-necked basilar tip aneurysm, with height of 14 mm. B) As the aneurysm height exceeded the maximum available height of the WEB II, 2 coils were positioned within the aneurysm after WEB II deployment. This combined technique was described by Pierot et al. (see text for details) and appeared safe and effective. C) DSA performed 9 months after treatment shows complete exclusion of the aneurysm from the intracranial circulation and normal patency of the posterior cerebral arteries.
Figure 4
Figure 4
A,B) CTA and DSA showing an irregularly shaped basilar tip wide-necked aneurysm, oriented anteriorly and laterally to the right. The posterior cerebral arteries and superior cerebellar arteries originate in proximity of the aneurysm neck. C) After WEB II deployment, a marked decrease of intra-aneurysmal blood flow can be observed. The patency of both posterior cerebral arteries and superior cerebellar arteries is maintained. D) DSA performed 8 months after treatment shows a small residual neck in the basilar tip aneurysm as well as preserved patency of all the blood vessels originating in proximity of the aneurysm neck.
See this image and copyright information in PMC

Comment in

  • Letter to the editor.
    Spelle L, Liebig T. Spelle L, et al. Neuroradiol J. 2014 Jun;27(3):369. doi: 10.15274/NRJ-2014-10048. Epub 2014 Jun 17. Neuroradiol J. 2014. PMID: 24976208 Free PMC article. No abstract available.

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