PMC9699850_01
(a) Magnetic resonance angiography showing an unruptured aneurysm at the cavernous portion of the left internal carotid artery. (b) 3D rotated angiography showing a saccular aneurysm at the C4 portion, with a size of 9.4 mm x 9.1 mm, a neck of 8.0 mm, and a depth of 6.9 mm (aspect ratio of 0.8). (c) Cone-beam computed tomography performed after the procedure shows a stent fitted well into the artery.
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F1
The aneurysm was a saccular aneurysm at the C4 portion of the ICA with a size of 9.4 mm x 9.1 mm, a neck of 8.0 mm, and a depth of 6.4 mm (aspect ratio of 0.8) [Figures 1a and b]. Post-dilatation was not performed as cone-beam computed tomography showed that the stent fitted well into the artery [Figure 1c].
(a) Left internal carotid arteriography before the procedure in the arterial phase. (b) Arterial phase after the procedure showing partial areas with no inflow of contrast that were present within the aneurysm. (c) Capillary phase before procedure showing no stagnation of blood flow within the aneurysm. (d) Capillary phase after the procedure showing stagnation within the aneurysm.
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F2
A comparison of pre and postoperative angiograms showed that the contrast did not enter into the inflow zone of the aneurysm in the arterial phase [Figures 2a and b]. In the capillary phase, there were areas of contrast stagnation [Figures 2c and d].
(a) Magnetic resonance angiography showing left internal carotid-cavernous fistula. (b) Left carotid angiography showing reflux into the superior ophthalmic vein and superficial middle cerebral vein. (c) Left carotid angiography after the procedure shows little flow to the cavernous and inferior petrosal sinuses and no cortical reflux. Therefore, we decided to complete the transvenous embolization.
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F3
MRI showed the occurrence of a left internal carotid-cavernous fistula (CCF; Figure 3a) due to rupture of the treated aneurysm. Cerebral angiography showed venous reflux into the superior ophthalmic vein (SOV) and superficial middle cerebral vein [Figure 3b]. Although the shunt remained after the procedure, cortical venous reflux disappeared [Figure 3c].