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