Case of simultaneous treatment of left giant vertebral aneurysm, left internal carotid aneurysm and left pre cerebral internal carotid artery stenosis.

A 62-year-old male was hospitalized at the SO «Scientific and Practical Center of Neurroradiology NAMS of Ukraine» with sever headache with a sudden onset. According to CTА – giant vertebral aneurysm.

Neurologically: In conscious . GCS – 15 point. Hunt- Hess II Grade. Moderate meningeal signs. Spontaneous horizontal nystagmus. No cranial nerves palsies. All neurological exams were unremarkable.

Cerebral angiography: – a giant left vertebral artery aneurysm in the V4 segment, left supraclinoid wide neck ICA aneurysm 3.2 mm in diameter with distal direction of the dome, critical stenosis (75%) of the left extracranial internal carotid artery.

Surgical intervention was performed: endovascular implantation of a flow-diverter stent into the left vertebral artery in V4 segment at the level of a giant aneurysm, total occlusion of the ICA aneurysm (coiling + balloon assistance), angioplasty with stenting of the critical stenosis of the left internal carotid artery.

There were no complications. Meningeal and cerebral symptoms regressed completely.

Discharged with favorable outcome.

Giant aneurysm in the V4 segment of the left vertebral artery

Left supraclonoid internal carotid artery aneurysm

Critical stenosis (75%) of left internal carotid artery

Giant aneurysm in the V4 segment of the left vertebral artery

Аfter endovascular implantation of a flow-diverter in left vertebral artery at the level of a giant aneurysm.

Total reconstructive occlusion of the aneurysm (coiling+ balloon assistance)

Angioplasty with stenting of the left ICA.

Image after procedure. The points of stents in ICA and VA, coils in projection of the ACom aneurysm

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