PMC3573798_01
a Contrast CT scan of the brain showing the right internal carotid aneurysm entering the sphenoid sinus. b Angiographic reconstruction of the 8 x 7-mm saccular aneurysm. c Complete aneurysm occlusion after coiling.
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F1
Rhinoscopy and CT angiography demonstrated a right internal carotid artery (ICA) aneurysm extending into the sphenoid sinus (fig. 1a). Cerebral angiography including 3D rotational digital subtraction angiography (3D-DSA) was performed, and the size and geometry of the aneurysm were accurately evaluated (fig. 1b). A complete exclusion of the aneurysm with patency of the carotid artery was obtained (fig. 1c).
Control angiography. a The aneurysm appears enlarged (11 mm in diameter) and the neck partly patent. b Nearly complete aneurysm occlusion after coiling. c Further aneurysm growth and recanalization despite two coiling procedures. d Flow-diverter stent positioning in the right ICA.
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F2
The patient was referred again to our hospital, and a new DSA showed a partial recanalization of the neck with an overall aneurysm growth (fig. 2a). A second endovascular coiling was attempted, resulting in an almost complete aneurysm exclusion (fig. 2b). The follow-up DSA performed 1 week later showed a new recanalization and further enlargement of the aneurysm (fig. 2c). Therefore, a flow-diverter stent (Pipeline, ev3, Irvine, Calif., USA) was placed across the aneurysm neck (fig. 2d).