Abstract
Internal carotid artery (ICA) anterior wall aneurysm is relatively rare, but is well-known for its high risk of intraoperative rupture. Because of its characteristic clinical features, it has been suggested that its pathogenesis differs from other usual saccular aneurysms. We encountered 3 cases with this sort of aneurysm, which was considered to be caused by the dissection of the ICA.
Case 1 was 46-year-old female with subarachnoid hemorrhage due to rupture of the ICA anterior wall aneurysm. Trapping of the ICA and STA-MCA anastomosis were performed, and the aneurysm was resected together with the ICA. Its photomicrographs showed intramural hematoma at the aneurysm neck. Case 2 was 57-year-old female whose initial carotid angiography revealed a IC-posterior communicating artery aneurysm with a retention of the contrast media on C2 anterior wall portion. During operation, the blister-like aneurysm was seen on this portion, and bleeding occurred from the aneurysm. Case 3 was 32-year-old female whose initial carotid angiography revealed double lumen and a retention of the contrast media on C2 portion. It was confirmed operatively that the blister-like aneurysm was on the C2 anterior wall portion and that the bleeding occurred from this portion.
These cases suggest that some of such aneurysms are caused by the dissection of the ICA. As to the treatment, a preoperative Matas test is necessary, and the balloon catheter should be set at the ICA prior to surgery. And in the case with the findings suggesting the dissection of the ICA on angiography, trapping of the ICA must be taken into acount to avoid recurrent bleeding.
