PMC3108449_01
Presence of a giant aneurysm from the supraclinoid tract of the right carotid siphon, digital subtraction angiogram in anterior-posterior craniocervical view
SNI-2-46-g001.jpg
PMC3108449_01_SNI-2-46-g001.jpg
F1
The patient underwent to a cerebral angiography [Figures 1 and 2].
Presence of a large aneurysm from the supraclinoid tract of the left carotid siphon
SNI-2-46-g002.jpg
PMC3108449_01_SNI-2-46-g002.jpg
F2
The patient underwent to a cerebral angiography [Figures 1 and 2].
Right internal carotid artery occluded
SNI-2-46-g003.jpg
PMC3108449_01_SNI-2-46-g003.jpg
F3
Angiographic control demonstrated the complete exclusion of the right ICA giant aneurysm, but a right ICA occlusion was discovered [Figure 3].
Right intracerebral vascularization vicariated by the left circulation, digital subtraction angiogram after first intervention
SNI-2-46-g004.jpg
PMC3108449_01_SNI-2-46-g004.jpg
F4
The left carotid aneurysm remained unchanged [Figure 4].
Proximal kinking of the right internal carotid artery-middle cerebral artery bypass, magnetic resonance angiography
SNI-2-46-g005.jpg
PMC3108449_01_SNI-2-46-g005.jpg
F5
Endovascular exclusion of the left carotid siphon aneurysm, digital subtraction angiography in lateral view
SNI-2-46-g006.jpg
PMC3108449_01_SNI-2-46-g006.jpg
F6
The procedure was well-tolerated with no further neurological deficits or complications [Figure 6].
Area of segmental narrowing of the extracranial-intracranial high-flow bypass graft
SNI-2-46-g007.jpg
PMC3108449_01_SNI-2-46-g007.jpg
F7
Three months later, the patient underwent an angiographic study confirming a complete aneurysm occlusion, and demonstrating an area of segmental narrowing at the level of the previously revealed kinking of the proximal portion of the graft.The narrowing was graded 75% (NASCET method) [Figure 7].
Intraoperative angiography imaging showing the endovascular stenting of segmental narrowing of the Extracranial-intracranial high-flow bypass graft
SNI-2-46-g008.jpg
PMC3108449_01_SNI-2-46-g008.jpg
F8
The endovascular team then proceeded with an angioplasty and stenting of the graft [Figure 8].
Angiographic follow-up showing the patency of graft and robust flow to the middle cerebral artery territory
SNI-2-46-g009.jpg
PMC3108449_01_SNI-2-46-g009.jpg
F9
A follow-up angiogram performed 36 months later showed a widely patent graft and robust flow to the MCA territory [Figure 9].