PMC7193203_01
Admission AngioCT revealed a right intracavernous carotid artery (ICCA) aneurysm with signs of partial thrombosis without evidence of rupture (a). The patient experienced complete cavernous sinus syndrome in relation to progression of thrombosis of the ICCA aneurysm as a new AngioCT showed (b).
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F1
AngioCT revealed a right ICCA aneurysm with signs of partial thrombosis without evidence of rupture [Figure 1a]. AngioCT showed progression of the thrombosis with discrete mass effect [Figure 1b], so steroids and antiplatelet therapy were initiated. Angiography on admission confirmed the presence of a giant aneurysm of the anterior portion of the right ICCA [Figure 2a-c].
Right carotid angiography, anteroposterior (a) lateral (b) and oblique (c) projections, indicates a giant aneurysm (25 mm of main diameter, 9 mm neck width) at the cavernous segment of the right ICA. Left carotid angiography, anteroposterior projection, showing adequate collateral reserve via anterior communicating artery (d) and the aneurysm without filling of contrast after balloon occlusion at the proximal portion of the right ICA (e).
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F2
AngioCT showed progression of the thrombosis with discrete mass effect [Figure 1b], so steroids and antiplatelet therapy were initiated. Angiography on admission confirmed the presence of a giant aneurysm of the anterior portion of the right ICCA [Figure 2a-c]. A balloon test occlusion (BTO) was performed to evaluate the preoperative risk of ischemia without relevant findings and no evidence of retrograde filling of the aneurysm by anterior or posterior communicating arteries [Figure 2d and e].
AngioMR (3D time of flight magnetic resonance sequence) showing reduction of the aneurysm size and minimal residual filling of the aneurysm immediately after the procedure (a). Eight months after the common carotid artery ligation, new AngioMR revealed signs of aneurysm recanalization (b).
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F3
A cerebral magnetic resonance angiography (MRA) revealed decrease of the size of the aneurysm lumen and no ischemic lesions were detected [Figure 3a]. Nine months later, and without new neurological symptoms, signs of aneurysm growth were detected in a serial MRA [Figure 3b], and a new angiography was planned.
Nine months after common carotid artery ligation, a right vertebral angiography (lateral projection) showed partial recanalization of the intracavernous carotid artery (ICCA) aneurysm (a). Collateral supply was explained from external carotid artery through the occipital artery with an inverse flow to the internal carotid artery (ICA) (arrowheads). After cervical ICA surgical ligation, a new right vertebral angiography confirmed total occlusion of the ICCA aneurysm (b).
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F4
CCA angiogram showed the therapeutic occlusion of the right ICA, but the right vertebral angiogram demonstrated proximal partial recanalization of the ICCA aneurysm. Collateral supply was explained from the external carotid artery (ECA) through the occipital artery with an inverse flow to the ICA [Figure 4a]. Postoperative new angiography confirmed the total occlusion of the aneurysm [Figure 4b].
Last follow-up AngioMR showing the absence of flow in the right intracavernous carotid artery (a, 3D time of flight magnetic resonance sequence) and no evidences of ischemic lesions (b, diffusion-weighted imaging sequence).
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F5
After 6 years of follow-up, we have not detected refilling or thromboembolic events [Figure 5].