Difficult retreatment of unruptured cerebral aneurysm related to altered course of the left common carotid artery after left upper lung lobectomy: A case report

Background: The structure and shape of the aortic arch and common carotid artery affect the level of difficulty of endovascular treatment. Changes in arterial course following thoracic surgery can make catheter guidance difficult. We report a case of extremely difficult guiding catheter settlement for coil embolization due to deformation of the aortic arch following left upper lung lobectomy. Case description: A 70-year-old woman visited our hospital with headache as her chief complaint. Multiple unruptured cerebral aneurysms were incidentally detected on magnetic resonance imaging (MRI). Coil embolization was performed on an aneurysm at the bifurcation of the left internal carotid and left posterior communicating (L_IC-PC) arteries. Eleven months after coil embolization, left upper lung lobectomy was performed as treatment for lung cancer. Later, follow-up MRI revealed recanalization of L_IC-PC aneurysm due to coil compaction; therefore, we attempted to perform coil embolization again. Guiding catheter placement into the left internal carotid artery was difficult because the course of the left common carotid artery had changed following the first treatment. However, we managed to set the guiding catheter in the left internal carotid artery using a gooseneck snare via the right brachial artery, and the retreatment was successfully completed. Conclusion: It is important to evaluate the access route through the femoral artery before administering endovascular treatment after prior thoracic surgery.