From the Guidelines
The web device can be considered for treating pericallosal anterior cerebral artery brain aneurysms, given its design as an intrasaccular flow disruptor suitable for wide-necked bifurcation aneurysms. When considering the use of the web device for pericallosal anterior cerebral artery brain aneurysms, it's crucial to weigh the benefits and risks, including the aneurysm's size, location, and morphological characteristics, as well as the patient's age and medical comorbidities 1. The decision to use the web device should be made after a comprehensive angiographic evaluation to determine its suitability for the specific aneurysm, taking into account factors such as aneurysm size, neck width, and vessel anatomy. Key considerations include:
- The web device's mechanism of action, which involves disrupting blood flow within the aneurysm to promote thrombosis while preserving the parent vessel and branch arteries.
- The importance of dual antiplatelet therapy before the procedure and aspirin alone post-procedure to minimize complications.
- The potential benefits of endovascular treatment over surgical clipping, especially in terms of procedural morbidity and mortality, as suggested by studies such as the ATENA study 1.
- The need for careful patient selection, considering factors like age, medical comorbidities, and aneurysm characteristics, to ensure the best possible outcomes. Given the complexity of treating pericallosal aneurysms due to their deep location and proximity to critical brain structures, the web device offers a valuable alternative to traditional surgical clipping, provided that its use is carefully considered and planned based on the latest evidence and guidelines 1.
From the Research
Treatment of Pericallosal Anterior Cerebral Artery Brain Aneurysms
- The WEB device can be used to treat pericallosal anterior cerebral artery brain aneurysms, as shown in a study published in 2020 2.
- This study reported the off-label use of the WEB device in 11 patients with 12 aneurysms, including 2 aneurysms in the pericallosal artery.
- The results showed that the WEB device was successfully deployed in off-labeled locations, including the pericallosal artery, with no procedure-related deaths or symptomatic complications.
Alternative Treatment Options
- Other treatment options for pericallosal anterior cerebral artery brain aneurysms include surgical clipping through a mini anterior interhemispheric approach 3.
- This approach has been shown to be effective in treating distal anterior cerebral artery aneurysms, with a low rate of complications.
- Flow diversion using the Pipeline embolization device (PED) is also a viable option for complex anterior cerebral artery aneurysms, including those located in the pericallosal artery 4.
Combined Techniques
- The WEB device can be used in conjunction with stenting and/or coiling to overcome its limitations and achieve successful angiographic results 5.
- This combined approach can be used to treat complex aneurysms with unfavorable aspect ratios or wide necks.
- However, larger case series are required to further assess the safety and success of these combined techniques.