Triple Woven EndoBridge device strategy for recurrent basilar tip aneurysm: A case report

Coil embolization and surgical clipping are among the treatment options for acutely ruptured cerebral aneurysms. However, wide-neck aneurysms may necessitate stent placement, introducing dual antiplatelet therapy risks during subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB) intrasaccular device provides a unique solution for wide-neck aneurysms that does not require dual antiplatelet therapy.

This case report details a 56-year-old male with a recurrent basilar tip aneurysm, treated with three WEB devices. He presented with Hunt Hess grade 4 SAH and underwent initial embolization with a WEB 9 × 7.6 mm. He made a significant recovery, but recurrence of the aneurysm base was observed after 6 months. He underwent embolization with a second WEB 7 × 5.6 mm. A year later, follow-up angiography revealed a recurrence of the aneurysm base yet again, and he underwent embolization with a third WEB 5 × 3 mm.

This case demonstrates the application of the WEB for a ruptured aneurysm, obviating the need for dual antiplatelet therapy and minimizing the risks of re-rupture and extraventricular drain complications. It also demonstrates the technical feasibility of deploying three WEB devices in the same aneurysm, providing a strategy for challenging aneurysm recurrence. The WEB offers a safe approach for intrasaccular flow disruption with satisfactory occlusion rates for recurrent aneurysms.