PMC8326107_01
Preoperative magnetic resonance (MR) T1-weighted imaging showed a giant heterogeneous thrombus in the aneurysm with a maximum diameter of 38 mm (a and b). Contrast-enhanced MR imaging showed no remarkable contrast enhancement of the aneurysm wall (c and d).
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F1
Contrast-enhanced MR imaging (MRI) demonstrated poor contrast enhancement of the aneurysm wall which indicates little involvement of the vasa vasorum [Figure 1].
Preoperative left internal carotid artery angiogram showed small contrast depiction at the vicinity of the neck of the aneurysm (a). Three-dimensional angiography showed perforators originating in the vicinity of the aneurysm neck (b and c).
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F2
Digital subtraction angiography (DSA) showed small contrast depiction at the vicinity of the neck of the aneurysm with a diameter of 6.5 mm x 6.5 mm x 4.5 mm at the terminal part of the left internal carotid artery (ICA) [Figure 2].
A braided stent was deployed from the middle cerebral artery proximal to the internal carotid artery, along with shortening of the stent for enhancing the flow diversion effect (a); the contrast-enhanced cavity was tightly packed with hydrogel coils (b and c).
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F3
ICA with 25% shortening to enhance metal coverage ratio. using the push technique [Figure 3]. Intra-aneurysmal flow stagnation was seen after stent deployment, and coil embolization was subsequently performed by tightly packing the aneurysm with hydrogel coils over 50% coil length (Hydrocoil, Terumo, Tokyo, Japan).
Comparison of the aneurysm size before (a) and after (b) treatment. The aneurysm size was significantly reduced 13 months after stent-assisted coil embolization.
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F4
MRI performed 13 months after the treatment demonstrated remarkable shrinkage of the aneurysm [Figure 4].