Endovascular Trapping of Both Sides of a Cervical Fusiform Carotid Aneurysm Associated with Marfan Syndrome. Case Report

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Objective: We report a rare case of cervical internal carotid artery aneurysm associated with Marfan syndrome and the technical details of endovascular trapping.Case Presentations: A 23-year-old male who had been diagnosed with Marfan syndrome presented with dysphagia due to an enlarged left cervical pulsating mass. Imaging studies revealed a non-thrombosed, giant cervical internal carotid fusiform aneurysm measuring approximately 3–4 cm extending to the skull base. After bypass surgery between the superficial temporal artery and the middle cerebral artery, endovascular trapping of the cervical internal carotid artery at both sides of the aneurysm was performed under flow control without positioning any coils inside the aneurysm itself. A 6F distal access catheter technique through the aneurysm and double or triple microcatheter technique were useful for tight and short-length occlusion of the artery combined with a proximal balloon guiding catheter. Dysphagia resolved after treatment due to alleviation of the compression on the recurrent nerve and disappeared completely within 3 weeks.Conclusion: Distal access catheter and multiple microcatheters under proximal flow control can be useful for endovascular trapping of both sides of a cervical fusiform aneurysm.