Ruptured brain aneurysm in VWD patient treated with W-EB device
Less invasive approach used to reduce bleeding risk from surgery
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The case of a woman with von Willebrand disease type 1 who developed a ruptured brain aneurysm was described in a recent report.
The woman successfully underwent a less invasive endovascular procedure, with VWD treatments used to prevent abnormal bleeding following the surgery. Aneurysms in people with VWD are considered rare, the researchers noted, adding that this is the first reported use of a Woven EndoBridge (W-EB) device in a person with VWD.
The paper, “Ruptured Anterior Communicating Artery Aneurysm Associated with von Willebrand Disease Treated Using the Woven EndoBridge Device: An Illustrated Case,” was published in the Journal of Neuroendovascular Therapy.
VWD affects blood clotting and increases bleeding risk
VWD is a genetic disorder marked by deficiency of von Willebrand factor (VWF), a protein needed for the blood to clot. Low levels of VWF can lead to symptoms such as easy or prolonged bleeding. In type 1 VWD, functional VWF protein is present but levels are endoabnormally low.
An aneurysm is a condition in which a weakened area of a blood vessel bulges outward, filling with blood like a balloon. In some cases, the aneurysm can rupture, leading to internal bleeding.
There are only a few published cases of people with VWD experiencing aneurysms, so there is limited data to guide clinicians when treating this complication. Here, researchers in Japan reported the case of a woman in her 50s with VWD who developed sudden headache and nausea. At the hospital, doctors found she had a ruptured anterior communicating artery aneurysm, a common location for brain aneurysms.
Less invasive approach used due to bleeding risk from surgery
Ruptured aneurysms are often managed with surgery, but because of this woman’s underlying VWD, clinicians worried that surgery to access the blood vessels in her brain would pose too high a bleeding risk.
Instead, she underwent an endovascular procedure — a less invasive approach in which a small incision is made in the leg and a thin tube is guided through the blood vessels to reach the aneurysm in the brain. Doctors then implanted a Woven EndoBridge device, which works by reducing blood flow into the aneurysm, helping to seal it off.
“To the best of our knowledge, this is the first reported case of [Woven EndoBridge] placement for VWD,” the researchers noted.
After the procedure, and for several days afterward, the woman was given treatment with a FVIII/VWF concentrate, a medication that contains purified VWF along with another clotting protein (FVIII). The procedure and recovery were uneventful, and the patient was able to leave the hospital about three weeks after the treatment.
“Despite the inherent bleeding risks associated with VWD, careful perioperative coordination with hematology specialists and appropriate replacement therapy with VWF/FVIII concentrate enabled the safe placement of a [Woven EndoBridge] device without [bleeding-related] complications,” the researchers concluded.
