PMC4900029_01
63-year-old female with anterior-wall aneurysm of the ICA. 3D computed tomography scan angiogram (CTA) delineating a tiny bulge ("blood blister-like" aneurysm) on the surface of the anterior wall of the distal right internal carotid artery (arrow) (ICA).
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A 63-year-old woman suffered from a subarachnoid hemorrhage, and was admitted to another hospital. 3D CT angiography (CTA) and angiography showed a tiny bulge (a "blood blister-like" aneurysm) on the surface of the anterior wall of the distal right ICA (Fig. 1A). Fourteen days later, re-rupture of the aneurysm occurred. 3D-CTA and conventional angiography demonstrated that the blister-like aneurysm had progressed to a saccular type (Figs. 1B and 1C). A microcatheter (Prowler Select Plus, Codman, J & J, USA) was advanced into the right middle cerebral artery (MCA) beyond the aneurysm (Fig. 1A), and a self-expanding nitinol stent 28mm in length (Enterprise, Codman, J& J, USA) was put in place from the M1 portion of the MCA to the paraclinoid portion of the ICA to cover the normal arterial wall beyond the aneurysm. Angiography immediately after the stent placement showed disappearance of the aneurysm (Fig. 1D); repeated angiography 10 minutes later also showed no aneurysm, so additional stent placement was not performed.
63-year-old female with anterior-wall aneurysm of the ICA. 3D-CTA 14 days after the initial symptoms, just after the aneurysm re-ruptured, shows progression to a saccular type aneurysm (arrow), clearly demonstrable by angiography (arrow) (Fig. 1C).
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The clinical course was uneventful, and followup angiography at three days and then two months (Fig. 2A) after the treatment showed no aneurysm. However, followup 3D-CTA at the two-month time point did reveal reccurence (Fig. 2B). Since additional followup 3D-CTA three months after the treatment showed remarkable diminution in the size of the aneurysm (Fig. 2C), no further treatment was planned. After four months, the aneurysm had disappeared (Fig. 2D), and the clinical course was subsequently uneventful without neurological deficit.