PMC3655272_01
Case 1. Preoperative cerebral angiogram showing the aneurysm in the left ICA. (a) Oblique view, showing aneurysm. (b) Conventional anteroposterior (AP)view, showing original caliber of the ICA terminus. Note the accessory left MCA off the ICA, supplying the posterior left temporal lobe, an anatomic variant.
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Cerebral angiography demonstrated a 2-mm left internal carotid artery (ICA) aneurysm in the superior hypophyseal region (Fig. 1).
Case 1. Coronal T1-weighted and MR imaging after contrast enhancement showing marked left supraclinoid ICA thickening and enhancement (arrows).
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This scan demonstrated vessel wall thickening and enhancement of the ICA extending from the posterior communicating artery (PCOM) region to the anatomic terminus, including the proximal A1 segment of the anterior cerebral artery (ACA) and proximal M1 segment of the middle cerebral artery (MCA) (Fig. 2).
Case 1. Left ICA angiograms obtained at 5-month follow-up examination showing left ICA terminus stenosis. AP view. Compare to original preoperative angiogram (Fig. 1b). Note the lack of antegrade flow in the left ACA, as well as the stenosis at the ICA terminus/proximal MCA region (arrow).
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Cerebral angiography confirmed corresponding moderate luminal stenoses in these areas, with resultant partial flow obstruction in the left MCA and no antegrade flow in the left ACA (Fig. 3).
Case 1. Cerebral angiogram obtained at 9-month follow-up. (a) AP view of the ipsilateral left ICA. Note progression of the terminal ICA stenosis to occlusion (arrow). (b) Anteroposterior view of the contralateral right ICA. Note retrograde opacification of the left A1 stenosis (arrow) and extensive leptomeningeal collateral formation.
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Cerebral angiography (Fig. 4) demonstrated severe, near-occlusive stenosis of the left terminal ICA with further leptomeningeal collateral vessel enlargement to the suprasylvian MCA territory.
PMC3655272_02
Case 2. Preoperative anteroposterior cerebral angiogram showing the left ICA aneurysm before wrapping (arrow). Note the baseline vessel luminal caliber.
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Cerebral angiography demonstrated a blister aneurysm arising medially from the left ICA, near the region of the left superior hypophyseal artery (Fig. 5).
Case 2. One-month follow-up: (a) lateral left ICA cerebral angiogram. Note the significant ICA stenosis (arrow) and lack of left ACA filling. (b) Angiogram of the contralateral right ICA. Note retrograde opacification of the left carotid terminus stenosis (arrow).
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M1 segment of the MCA (Fig. 6). MRI of the brain demonstrated an enhancing mass around the muslin-wrapped artery, extending to the distal ICA bifurcation, consistent with granuloma.