J Cerebrovasc Endovasc Neurosurg.  2023 Jun;25(2):203-207. 10.7461/jcen.2022.E2022.07.003.

Aneurysmectomy and graft interposition for giant thrombosed proximal internal carotid artery aneurysm: Technical details

• Baek KD
• Kim JH
• Kang HI
• Jwa CS
• Bae IS
• Shin SH

• KMID: 2543517
• DOI: http://doi.org/10.7461/jcen.2022.E2022.07.003

Abstract

A giant thrombosed extracranial internal carotid artery aneurysm (ECCA) is extremely rare and its treatment is challenging. Despite the advance of endovascular technique, open surgery is still considered a first-line treatment in giant thrombosed ECCA. We describe a case of giant thrombosed ECCA which was successfully treated by aneurysmectomy and graft interposition with the technical details.

Keyword

Aneurysm; Transplants; Thrombosis

Figure

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  Fig. 1. (A) Brain diffusion weighted image showing high signal intensity in right caudate nucleus and periventricular white matter. (B, C) Cerebral angiography showing a thrombosed extracranial carotid artery aneurysm and occlusion of the mid-portion of the right middle cerebral artery. (D) Right common carotid artery angiogram showing tortuous common carotid artery. (E, F) Neck 3-dimentional angiogram showing complete recanalization of the right middle cerebral artery and 4 cm sized extracranial carotid artery aneurysm with contrast filling and thrombus.

• 

  Fig. 2. (A) Intraoperative photography showing the aneurysm stuck to the internal and external carotid artery at the bifurcation of the common carotid artery. (B) Schematic drawing depicting the placement of carotid shunt and interposition graft following aneurysmectomy. After partial resection of the aneurysm leaving posterior wall, the anastomosis is initially performed at the proximal internal carotid artery with a continuous non-locking fashion and then the distal internal carotid artery. (C, D) Schematic drawing and intraoperative photography showing the completion of the graft interposition procedure. After removal of carotid shunt, the arteriotomy site is secured. (E, F) Three-dimensional computed tomographic angiography taken 7 days after surgery and magnetic resonance angiography taken one year later demonstrating no residual aneurysm and patent interposition graft. ECA, external carotid artery; CCA, common carotid artery; ICA, internal carotid artery

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