J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):303-308. 10.7461/jcen.2014.16.3.303.

Combination Treatment for Rapid Growth of a Saccular Aneurysm on the Internal Carotid Artery Dorsal Wall: Case Report

• Choi JH
• Kim TH
• Park SK
• Hwang YS
• Shin HS
• Shin JJ

• KMID: 1963172
• DOI: http://doi.org/10.7461/jcen.2014.16.3.303

Abstract

Aneurysms arising from non-branching sites of the supraclinoid internal carotid artery (ICA) are considered rare, accounting for only 0.9-6.5% of all ICA aneurysms. They are thin-walled, broad-based, can easily rupture during surgery, and are referred to as dorsal, superior, anterior, or ventral wall ICA aneurysms, as well as blister-like aneurysms. Various treatment modalities are available for blister-like aneurysms, but with varying success. Here, we report on two cases of saccular shaped dorsal wall aneurysms. Both patients were transferred to the emergency department with subarachnoid hemorrhage because of an aneurysmal rupture. Computed tomography angiography and transfemoral cerebral angiography (TFCA) showed a dorsal wall aneurysm in the distal ICA. We performed clipping on the wrapping material (Lyodura(R), temporal fascia). Follow-up TFCA showed rapid configuration changes of the right distal ICA. Coil embolization was also performed as a booster treatment to prevent aneurysm regrowth. Both patients were discharged without neurologic deficit. No evidence of aneurysm regrowth was observed on follow-up TFCA at two years. Dorsal wall ICA aneurysms can change in size over a short period; therefore, follow-up angiography should be performed within the short-term. In cases of regrowth, coil embolization should be considered as a booster treatment.

Keyword

Dorsal wall aneurysm; Subarachnoid hemorrhage; Wrapping; Coiling

MeSH Terms

Aneurysm*
Angiography
Carotid Artery, Internal*
Cerebral Angiography
Embolization, Therapeutic
Emergency Service, Hospital
Follow-Up Studies
Humans
Neurologic Manifestations
Rupture
Subarachnoid Hemorrhage

Figure

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  Fig. 1 (A) Transfemoral cerebral angiography (TFCA) showing a broad-based aneurysm in the right distal internal carotid artery (ICA). (B) Intraoperative photo showing the dissected aneurysm. (C) Follow-up TFCA showing growth of the right distal ICA aneurysm. (D) Embolization was performed for the right ICA aneurysm.

• 

  Fig. 2 (A) Transfemoral cerebral angiography (TFCA) showing no definite aneurysm, but there is evidence of a subtle bulging lesion in the right internal carotid artery (ICA). (B) Follow-up TFCA showing an aneurysm in the right distal ICA. (C) Intraoperative photo showing the saccular aneurysmal rent. (D) Follow-up angiography at one month showing growth of the aneurysm (E) Coil embolization was performed. (F) Follow-up angiography at two years showing no residual aneurysm.

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