Abstract
A 42-year-old man presented with a ruptured aneurysm associated with unilateral internal carotid aplasia. He came to our hospital because of disturbed consciousness and left hemiparesis. Computed tomography showed an intraparenchymal hematoma in the right thalamic region without subarachnoid hemorrhage. Cerebral angiography demonstrated an aneurysm arising from a dilated and tortuous posterior communicating artery. The right internal carotid artery was totally absent. On coronal magnetic resonance imaging, the aneurysm was not thrombosed. Coil embolization of the aneurysm was performed by an endovascular technique using two microcatheters. In the first procedure, after achievement of coil stability with two initial coils without arterial compromise, the dome was packed mainly in the distal portion of the aneurysm to prevent rebleeding. Six months later, coil compaction was present and a re-coiling procedure was performed. In the second procedure, the dome of the aneurysm was compactly occluded. His postoperative course was uneventful. In this case, clipping or trapping of the aneurysm with an EC-IC bypass procedure was contraindicated due to the risk of causing confinement of the posterior communicating artery and perforating arteries. Therefore we chose endovascular treatment. However, continued monitoring of this patient will be necessary in the future.
