Coiling of a Ruptured Large Internal Carotid Artery Aneurysm via Extracranial-Intracranial Saphenous Vein Bypass Graft Just After Proximal Ligation of the Internal Carotid Artery.

BACKGROUND: Combined direct and endovascular surgery has been performed to treat large to giant internal carotid artery (ICA) aneurysms. This report describes successful treatment of a large ICA aneurysm by coiling of the aneurysm via an extracranial-intracranial saphenous vein (SV) graft just after bypass and ICA proximal ligation.

CASE DESCRIPTION: A 66-year-old woman presented with a left ICA supraclinoid aneurysm with progressive visual field defect and impaired visual acuity in the left eye. While waiting for scheduled surgery, she experienced a subarachnoid hemorrhage. An extracranial-intracranial high-flow bypass using an SV graft and proximal ligation of the ICA were performed. Coiling of the aneurysm was immediately performed successfully via the SV bypass graft. The patient experienced no new neurologic deficit after this treatment. Follow-up radiologic evaluations using magnetic resonance imaging and magnetic resonance angiography revealed complete aneurysm occlusion.

CONCLUSIONS: Aneurysm coiling via an extracranial-intracranial SV bypass graft could offer an alternative when an antegrade access route to the ICA is not used because of prior parent artery ligation.