Delayed aneurysm rupture following treatment with the WEB embolization device

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Cerebrovascular Disease

Background:

• The Woven EndoBridge (WEB) device is utilized for embolizing intracranial aneurysms.
• Anterior communicating artery (ACoA) aneurysms present unique treatment challenges.
• Delayed aneurysm rupture post-embolization is an uncommon complication.

Observation:

• A patient with a multiply ruptured ACoA aneurysm underwent successful WEB device embolization.
• Post-procedure imaging confirmed no immediate complications or rebleeding.
• Four hours post-embolization, the patient experienced a sudden increase in intracranial pressure with signs of hemorrhage.

Findings:

• A subsequent CT scan revealed new parenchymal and intraventricular hemorrhage.
• The ruptured aneurysm was treated with microsurgical clipping.
• Intraoperative findings did not reveal an obvious rupture point or uncovered WEB device component.

Implications:

• This case suggests that delayed aneurysm rupture can occur even after successful WEB embolization.
• Close neurological monitoring is crucial in the immediate post-procedure period for patients treated with WEB devices.
• Further research is needed to understand the mechanisms and risk factors for delayed rupture after WEB embolization.