Microsurgical clipping of a recurrent anterior communicating artery aneurysm following WEB intrasaccular embolization: illustrative case.

Abstract

<h4>Background</h4>The Woven EndoBridge (WEB) embolization system is an endovascularly deployed intrasaccular device that promotes occlusion in cerebrovascular aneurysms through intra-aneurysmal thrombosis. While the safety and efficacy of the WEB device have been well described in the literature, the treatment of recurrent aneurysms after WEB embolization via microsurgical clipping requires further study.<h4>Observations</h4>A 71-year-old female patient with an incidentally discovered anterior communicating artery aneurysm underwent WEB embolization with complete aneurysm occlusion observed on immediate postintervention angiography. Catheter angiography both 9 and 18 months after embolization revealed aneurysm recanalization. Given the aneurysm's wide neck and irregular dome, the patient underwent an uncomplicated left pterional craniotomy for microsurgical clipping of the recurrent aneurysm 21 months after initial WEB embolization. Intraoperative angiography confirmed complete aneurysm occlusion. Follow-up catheter angiography 12 months later demonstrated persistent aneurysm occlusion with preservation of parent and adjacent vessels.<h4>Lessons</h4>The compressibility of the WEB device with aneurysm clips and the device's tendency to remain intrasaccular after clipping make microsurgical clipping a favorable treatment option for aneurysmal recurrence after WEB embolization in appropriate surgical candidates. Further dedicated studies evaluating outcomes after microsurgical clipping for recurrent or residual aneurysms after WEB embolization are warranted. https://thejns.org/doi/10.3171/CASE25340.