case_images: PMC11731181_01
case_images: The carotid aneurysm located at the internal carotid artery and compressed the C1 segment, emanated from the distal end of the C1 segment at an angle of 90 , and the distal end of it formed three more 90  angles then traveled upward to the C2 segment. The anatomical characteristics of the aneurysm indicated that the endovascular repair was impossible.
case_images: rjae849f1.jpg
case_images: PMC11731181_01_rjae849f1.jpg
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case_images: After hospitalized, the computed tomography angiography (CTA) of neck and head was performed, showed an aneurysm from C1 to C2 segment of the internal carotid artery and incomplete circle of Willis (Fig. 1).
case_images: (A) Following routine disinfection and sterile draping, local anesthesia was injected, a transverse 3 cm incision was made  2 cm above the sternal notch along the dermatome of the left neck. After the exposure of the left common carotid artery, an 8-French catheter was looped around the common carotid artery, with the tail of the catheter passed through the incision in a vertical orientation. (B) A short section of the T-tube was attached to the external part of the catheter and secured to prevent loosening. Upon tightening the catheter, aneurysm pulsation ceased, indicating successful blockage, and pulsation returned upon loosening the catheter, the platysma and skin were sutured.
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case_images: PMC11731181_01_rjae849f2.jpg
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case_images: Surgical outcomes are shown in Fig. 2.
case_images: (A) After systemic heparinization with systemic heparin injection and clamping of the distal C1 and proximal C2 segments, the aneurysm was completely resected, resulting in a successful anastomosis. (B) An in situ internal carotid artery-to-internal carotid artery anastomosis was performed, demonstrating no blood leakage and strong distal pulsation.
case_images: rjae849f3.jpg
case_images: PMC11731181_01_rjae849f3.jpg
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case_images: The aneurysm was completely resected, resulting in a successful anastomosis (Fig. 3).