Presentation
Incidental finding.
Patient Data
The MRA shows a left carotid cave aneurysm projecting 4 mm medially and having a 2 mm neck. There is also subtle protuberance at the infero-medial aspect of the right internal carotid artery in a similar location, suspicious for a further (albeit smaller) aneurysm.
Unruptured 4.5 millimeter medially projecting transitional aneurysm of the left internal carotid artery, carotid cave, likely totally or in part intra dural. Patient elects for treatment.
Informed consent obtained in clinic. Pre-medicated with 100mg Aspirin and 75 mg Clopidogrel for 4 days. Sterile technique. Right 6-F CFA retrograde sheath. Systemic heparinisation. Diagnostic angiography confirm no change from the recent study.
6-French Cook shuttle sheath into the left internal carotid artery, 6-French neuron guide catheter, SL 10 90\XB0\, and Scepter C 4 x 10 balloon catheter placed. Balloon remodeling-5 coils placed, Target 360 standard, soft, and Ultra soft respectively: 4 x 15:3 x 6:2 x 4, 2 x 4, 2 x 3 Raymond class 1-complete obliteration aneurysm, no major graphic complication, no stent placed.
No coil related or embolic complications detected.
Case Discussion
Carotid cave aneursyms have a complex relationship to the dura, and it is difficult to determine on imaging if they intra or extradural. Their neck is considered intradural and in general they are thus thought to present a risk for subarachnoid hemorrhage (which purely extradural cavernous sinus aneurysms do not).