A giant anterior communicating artery aneurysm associated with hypoplasia of the unilateral internal carotid artery

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Objective: There have been few reports on the association of large or giant aneurysms with congenital absence or hypoplasia of the internal carotid artery (ICA). We present a case of a giant anterior communicating artery aneurysm associated with hypoplasia of the unilateral ICA with secondary occlusion.
Case presentation: A 62-year-old man was diagnosed with a giant anterior communicating artery aneurysm (10×12×28 mm) associated with hypoplasia of the unilateral ICA. A left common carotid angiogram revealed occlusion of the cervical portion of the left ICA. A right internal carotid arteriogram showed the aneurysm. Both the left anterior cerebral artery and left middle cerebral artery were filled from the right ICA via the anterior communicating artery. Due to the complicated morphology and calcified wall of the aneurysm, we performed endovascular treatment using a combination of 18- and 10-series microcatheters to make separate coil frames in the aneurysmal sac. Twenty-seven Guglielmi detachable coils with a total length of 419cm were placed in the aneurysm, which resulted in satisfactory occlusion. The patient was discharged without complications, and there was no evidence of aneurysmal recurrence for three years.
Conclusion: Large or giant aneurysms associated with congenital absence or hypoplasia of the ICA are rare. In their treatment them, it is important to avoid a decrease in collateral blood flow. The endovascular procedure is a reasonable therapeutic option.