PMC7398405_01
Magnetic resonance imaging shows an aneurysm of the left internal carotid artery. a Enhanced scanning shows mild uneven enhancement and heterogeneous signal intensities representing variable stages of thrombosis. b T2 magnetic resonance imaging shows aneurysm is low signal and blood vessel wall calcification
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Fig1
There was a circular liquid signal shadow spotted under the inner wall of the left maxillary sinus, the diameter of which was about 16 mm (Fig. 1).
The left internal and external carotid angiography. a Balloon occlusion test showed patency of anterior communicating artery. b-c Digital subtraction angiography anteroposterior and lateral views display the separate inflow and outflow channels of the giant serpentine aneurysm; Weakening of contrast medium filling at the distal end of the channel. d Left external carotid artery angiography suggests intramaxillary aneurysms
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Fig2
Further cerebral angiography indicated that the left internal carotid artery GSA was about 48.61 mm x 23.40 mm in size, 4.65 mm in diameter of proximal vessels, and 3.16 mm in diameter of distal vessels (Fig. 2).  
Three-dimensional vascular reconstruction to show the morphology of stents. a The overlap of the middle part of the stents is clearly visible. b The end of the bracket is stretched and anchored. c Specific structure of stents and GSA
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Fig3
Tubridge and LEO stent (Fig. 3). Then, the guide catheter to the external carotid artery was replaced, liquid glue (50%, 1.5 ml) was injected, and three coils were released through the microcatheter.
Postoperative follow-up of CT and DSA. a Left internal carotid artery angiography shows the redirection of the aneurysm inflow jet. b External carotid arteriography shows complete occlusion of MA. c Postoperative reexamination of CT. d DSA reveals the variation of flow direction in the stents. e-f 3D-DSA display the transform volume and morphology of GSA
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Fig4
Three-dimensional revascularization indicated a significant reduction in aneurysm volume, and the mass effect was reduced as shown by CT scan (Fig. 4).