PMC5030425_01
Nonenhanced axial CT slices ((a) and (b)) show three round hyperdensities: one adjacent to the sphenoid corpus on the left, another in front of the mesencephalon, and the third in the Sylvian fissure on the left, implying aneurysms of the internal carotid artery (ICA) cavernous segment (arrow, (a)), basilar tip (dashed arrow, (b)), and middle cerebral artery (white arrow, (b)), respectively. The DSA of the left carotid artery (c) reveals a small wide-necked aneurysm of the ICA lacerum segment (black dashed arrow, (c)), a fusiform aneurysm of the ICA cavernous segment (black arrow, (c)), and a middle cerebral artery bifurcation aneurysm (white arrows, (c) and (f)). A severe stenosis (white dashed arrow, (c)) adjacent to the fusiform aneurysm was also seen, resulting in reduced distal flow (c). 3D images ((d) and (e)) show the small saccular narrow-necked aneurysm of the anterior choroidal artery (white arrow, (d)) and the small saccular wide-necked aneurysm of the middle cerebral artery (e). A saccular wide-necked basilar tip aneurysm (f), a fusiform aneurysm of the anterior communicating artery (black arrow, (g)), and a saccular narrow-necked aneurysm (white arrows, (g) and (h)) and a blister-like (black arrows, (h)) aneurysm of the right ICA ophthalmic segment are seen in the DSA ((f) and (g)) and 3D (h) images. The ICA cervical segment dissection (i) possibly occurred during embolization of the aneurysms.
CRINM2016-9637905.001.jpg
PMC5030425_01_CRINM2016-9637905.001.jpg
fig1
The CT showed no SAH but round hyperdensities adjacent to the sphenoid corpus on the left, in front of the mesencephalon, and in the Sylvian fissure on the left implied internal carotid artery (ICA) cavernous segment, basilar tip, and middle cerebral artery (MCA) aneurysms, respectively (Figures 1(a) and 1(b)). Eight aneurysms were seen in the posterior circulation and, bilaterally, in the anterior circulation (Figure 1).  Table 1 shows the details of the aneurysm locations, characteristics, treatment technique, and stents. The fusiform aneurysm of the left ICA cavernous segment was partially thrombosed, and there was a severe stenosis at the distal part of the aneurysm (Figure 1(c)). Most of the left MCA blood flow came from the posterior communicating artery (PComA) due to the stenosis (Figure 1(f)).
The 9th-month follow-up DSA ((a), (b), and (c)) images show total closure of the aneurysms of the left ICA lacerum segment (a) and the cavernous segment (a), the left anterior choroidal artery (black arrow, (a)), the middle cerebral artery (white arrow, (a)), the basilar tip (b), the anterior communicating artery (black arrow, (c)), and the right ICA ophthalmic segment (white arrow, (c)). The intimal hyperplasia inside the stents seen in the 3rd-month follow-up angiograms (not shown here) was totally relieved. The coils and stents used for the treatment of the aneurysms are seen in the fluoroscopic image (d). A slight fusiform dilation and no in-stent stenosis are seen in the left ICA cervical segment dissection, which was treated with a carotid Wallstent (black dashed arrows, (a)). The 3rd-month DSA (not shown here) showed a slight narrowing, due to the fish mouth or foreshortening effect, inside the distal part of the Surpass stent used for the right ophthalmic segment aneurysms. The 9th-month follow-up DSA (c) showed no change (black dashed arrow, (c)) and no intimal hyperplasia.
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