PMC8326098_01
(Case 1) Brain magnetic resonance (MR) images (a-d) reveal a subacute cerebral infarct in the territory of the middle cerebral artery. Perfusion MR images (e-h) showed hypo-perfusion in the right hemisphere.
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F1
Brain MRI revealed a subacute cerebral infarct in the MCA territory; perfusion MRI showed hypoperfusion of the right hemisphere [Figure 1].
(Case 1) Cervical axial computed tomography scans (a and b) show a 33-mm extracranial carotid artery aneurysm (white arrow). The upper end of the aneurysm (a) is at the mandibular level. The left carotid artery angiogram (c, lateral view) shows an internal carotid artery (ICA) aneurysm with an irregular wall at the C2 level. (d) Postoperative angiogram confirming ICA occlusion and disappearance of the aneurysm and patency of the radial artery graft (arrowhead).
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Cervical MRI, computed tomography (CT) scans, and a right carotid artery angiogram showed an ICA aneurysm (33 mm) at the C2 level [Figure 2]. Cerebral angiography confirmed right ICA occlusion and disappearance of the aneurysm [Figures 2c and d].
PMC8326098_02
(Case 2) T2-FLAIR magnetic resonance imaging (MRI) axial image (a) shows no abnormal lesion. MRI perfusion images (b) reveal hypo-perfusion in the left cerebral hemisphere. Cervical computed tomography angiograms (c and d) and a left carotid artery angiogram (e) reveal a 36-mm left extracranial internal carotid artery aneurysm the level of C1 to C3. Part of the aneurysm is behind the mandible.
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Brain MRI showed no lesion, however, perfusion MRI revealed hypo-perfusion in the left hemisphere [Figure 3]. Cervical MRI, CTA, and angiography confirmed a left extracranial ICA aneurysm (36 mm) at the C2/C3 level [Figure 3].
(Case 2) Retrograde angiogram from the top of the left internal carotid artery (ICA) through the radial artery graft shows the aneurysm remnant (white arrow) (a). After the ICA was occluded by coil-embolization the aneurysm disappeared (b, c, d).
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We trapped the aneurysm by occluding the distal portion of the ICA intravascularly [Figure 4].