PMC7398328_01
CTA showed the left EICA giant aneurysm (arrow), measuring the lesion was 27 x 23 mm in diameter
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Fig1
Three-dimensional computed tomography angiography (CTA: Fig. 1) confirmed the giant aneurysm.
The ICA was reconstructed with end-to-end anastomosis (arrow), after the resection of the aneurysm
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Fig2
The continuity of the ICA was restored with end-to-end anastomosis between the two parts of the ICA (Fig. 2).
Cerebral DSA at the 5-month follow-up showed stenosis of the left ICA
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Fig3
Up to the 5 months follow-up period, the patient also had slight intermittent headache and dizziness, but digital subtraction angiography (DSA) showed excellent repair of the ICA only with a slight stenosis (Fig. 3).
PMC7398328_02
DSA showed a wide-neck EICA aneurysm with a maximal diameter of 9.8 x 10.5 mm at the C2 segment (arrow)
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Fig4
DSA demonstrated an aneurysm at the left EICA (Fig. 4).
After a WCS measured4.5 mm x 16 mm was deployed, angiogram demonstrated the stent was in a good position
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Fig5
Under local anesthesia, the patient was thoroughly heparinized, then the right femoral artery was canalized with an 8 Fr. super-long sheath (Shuttle TM sheath, Cordis), and an 8 Fr. guiding catheter (Cordis, Miami, FL, USA) was positioned in the proximal segment of the left ICA, and a PTCA guidewire (Boston, USA) was navigated into the distal part of the aneurysm, subsequently, a Willis covered stent (WCS) navigated over the microwire and bridged the aneurysm neck under a roadmap guidance (Fig. 5).
At a 7-month follow-up period, cerebral angiogram demonstrated the complete disappearance of the aneurysm
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Fig6
After the Willis has been deployed and expanded completely, an immediate final angiogram was performed (Fig. 6).
PMC7398328_03
DSA revealed an aneurysm at the distal part of the straight left EICA (arrow)
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Fig7
DSA (Fig. 7) confirmed an aneurysm located distally in the left EICA that was regarded responsible for the symptom.
After a 4.5 mm x 16 mm WCS was implanted, angiography revealed the aneurysm disappearance
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Fig8
The procedure was same to the abovementioned case 2 in detail (Fig. 8).