Endovascular treatment of bilateral internal carotid artery aneurysm

BACKGROUND: Aneurysms of the extra cranial internal carotid artery (ICA) are rare and caused by infection, arteriosclerosis, fibro muscular dysplasia, neurofibromatosis, Behcet disease, Ehlers-Danlos syndrome, radiotherapy, iatrogenic injury or trauma. Increasing number of high-risk patients and more accurate diagnosing of unapproachable lesions make the consideration of endovascular treatment more acceptable. METHODS: We are reporting a case of a 36-year-old male with bilateral aneurysms of ICA and a history of several transitory ischemic attacks. Bilateral successive implantation of a 19 mm long covered stent (Jostent) was performed, with a delay of one month between the two procedures. After exclusion of the right ICA with covered stent, patient developed transitory ischemic attack and control multi detector computed tomography revealed occlusion of the left ICA. RESULTS: Further recovery of the patient was uneventful and a control examination after 2 years show patent right ICA, occluded left ICA with no clinical consequences. CONCLUSIONS: Patients with recurrent symptoms associated with extra cranial aneurysm need prompt treatment. Surgical resection with various reconstruction techniques is established method. Endovascular exclusion by covered stent in surgically unapproachable aneurysms is feasible; however, there is still need for more technical improvement and experience before it becomes preferable treatment option.