PMC10442174_01
CTA and diagnostic angiogram. (A) Neck contrast-enhanced CT scan revealed a 55-mm right cervical ICA aneurysm and fracture of the elongated styloid process (55 mm) (arrow). (B and C) In the right ICA angiogram, a giant aneurysm of 50 x 60 mm was diagnosed, with the inflow portion of the aneurysm slightly distal to the ICA bifurcation. (B) Frontal view. (C) Lateral view. (D) On the maximum intensity projection image reconstructed from rotational DSA, the ICA diameter was 7.94 mm, the CCA diameter was 7.29 mm, and the minimum diameter of the ICA was 3.61 mm. CCA: common carotid artery; ICA: internal carotid artery
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F1
On admission, neck contrast-enhanced computed tomography revealed a 55-mm right cervical internal carotid artery (ICA) aneurysm and fracture of the styloid process (Fig. 1A). In the right ICA angiogram, a giant aneurysm of 50 x 60 mm was diagnosed, with the inflow portion of the aneurysm slightly distal to the ICA bifurcation (Fig. 1B and 1C). On the maximum intensity projection image reconstructed from rotational DSA, the ICA diameter was 7.94 mm and the common carotid artery (CCA) diameter was 7.29 mm (Fig. 1D).
Lateral view of right CCA angiogram during the treatment. (A) An 8-Fr guiding catheter (80 cm, Asahi Fubuki; Asahi Intecc, Aichi, Japan) was placed into the right CCA, and a 5-Fr intermediate catheter (115 cm, Sofia Select; Terumo, Tokyo, Japan) was introduced into the ICA distal to the aneurysm with a microcatheter (150 cm, SL10-STR; Stryker, Freemont, CA, USA) (arrow) and microguidewire (200 cm, Asahi Chikai 0.014-inch; Asahi Intecc). (B) After deployment of a FilterWire EZ (Stryker), a 5-Fr guiding catheter (90 cm, ENVOY; Cerenovus, Fremont, CA, USA) was also placed into the right CCA from the left femoral sheath. A microcatheter (Lantern 45 ; Penumbra, Alameda, CA, USA) was placed in the aneurysm using a microguidewire (Asahi Chikai 0.014-inch) from the 5-Fr guiding catheter (90 cm, ENVOY) (arrowhead). (C) A CASPER Rx 10- x 30-mm stent (Terumo) was deployed between the ICA distal to the aneurysm and CCA (double arrowheads). (D) A second CASPER Rx 10- x 30-mm stent was also deployed from a site more proximal than the first one (double arrows). CCA: common carotid artery; ICA: internal carotid artery
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Asahi Intecc) (Fig. 2A). A microcatheter (Lantern 45 ; Penumbra, Alameda, CA, USA) was placed in the aneurysm using a microguidewire (Asahi Chikai 0.014-inch) from a 5-Fr guiding catheter (90 cm, Envoy) (Fig. 2B). A FilterWire EZ was guided from the Sofia Select into the distal ICA and deployed, because the presence of a thrombus in the aneurysm required the use of FilterWire EZ for distal protection. A CASPER Rx 10- x 30-mm stent (Terumo) was deployed between the ICA distal to the aneurysm and CCA (Fig. 2C). The second CASPER Rx 10- x 30-mm stent was also deployed from a site more proximal than the first one (Fig. 2D).
Postprocedural right CCA angiogram (lateral view). (A) After the procedure, a marked decrease in blood flow into the aneurysm and blood flow stasis in the aneurysm were observed. (B) At the 6-month follow-up angiogram, blood flow into the aneurysm had completely disappeared. (C) At the 6-month follow-up angiogram, the axial plane of 3D-DSA reconstruction showed no blood flow into the aneurysm and the size of aneurysm was reduced from a maximum diameter of 6 cm to 4.8 cm in 6 months (black arrow). White arrow shows ICA, and arrowhead indicates coil mass. CCA: common carotid artery; ICA: internal carotid artery
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A right CCA angiogram after the procedure showed markedly decreased blood flow into the aneurysm and blood flow stasis in the aneurysm (Fig. 3A). At the 6-month follow-up angiogram, blood flow into the aneurysm had completely disappeared (Fig. 3B). Moreover, the size of aneurysm was reduced from a maximum diameter of 6 cm to 4.8 cm in 6 months (Fig. 3C).