PMC5588795_01
Axial CT demonstrating (a) thrombosed left paraclinoid aneurysm (arrow), (b) partial recanalization (arrow), and (c) complete recanalization after antithrombotic therapy (arrow).
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A head computed tomography angiogram (CTA) showed a 10 mm left paraclinoid thrombosed aneurysm (Figure 1(a)). A CTA of the head showed partial recanalization of the left paraclinoid aneurysm (Figure 1(b)).
(a) Axial CT demonstrates thrombus in right supraclinoid ICA (arrow) and (b) axial diffusion MRI sequence shows acute infarction left parietal lobe (arrow).
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The study also identified thrombus within the left supraclinoid internal carotid artery (ICA) (Figure 2(a)). Magnetic resonance imaging (MRI) of the brain showed a left parietal lobe acute infarct in the vascular territory of the left inferior division middle cerebral artery (Figure 2(b)). A head CTA 10 days later while the patient remained on heparin showed a completely recanalized left ICA aneurysm with resolution of thrombus at the left supraclinoid ICA (Figure 2(c)).
(a) Oblique projection digital subtraction angiography (DSA) demonstrating critical stenosis proximal to the paraclinoid internal carotid artery aneurysm. (b) Oblique projection unsubtracted angiogram showing restoration of luminal caliber post stent angioplasty. (c) Oblique projection fluoroscopic spot view showing the drug-eluting stent across the stenosis (arrow) and delivery of the Pipeline embolization device (short arrow). (d) Oblique projection DSA demonstrating aneurysm obliteration (arrow) without recurrent pre-aneurysmal stenosis.
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Pre-embolization digital subtraction angiography (DSA) identified critical stenosis of the cavernous ICA proximal to the aneurysm, not discernible by CTA (Figure 3(a)). A tandem Pipeline flow diverter embolization device (ev3, Irvine, CA, USA) was delivered through the resolved stenosis and aneurysm (Figure 3(b) and (c)). At 6-month follow-up, her right extremity paresis improved with complete occlusion of the aneurysm and no in-stent stenosis (Figure 3(d)).