Intracranial aneurysms may cause embolic stroke. Medical or surgical management is
selected on an individual basis, as the optimal treatment strategy has not been established.
A 79-year-old woman with a large cavernous carotid aneurysm suffered repeated embolic
stroke after enlargement and partial thrombosis of the aneurysm, in spite of antiplatelet
therapy. Coil embolization of the primitive trigeminal artery and ligation of the
internal carotid artery (ICA) at the cervical portion followed by high-flow bypass
from the cervical external carotid artery to the middle cerebral artery were performed.
The aneurysm was thrombosed, and prevention of further stroke was achieved. Acute
enlargement and thrombosis of large or giant cavernous carotid aneurysm may cause
repeated embolic stroke, and requires emergent exclusion of the aneurysm from circulation
by proximal ICA occlusion together with distal revascularization before devastating
embolic stroke occurs.
Key-words:
Cavernous carotid aneurysm - embolic stroke - high-flow bypass - proximal occlusion
- recurrence
