Double Carotid Artery Aneurysm
Boris Zurita –Cueva MD,
Marcela Solano MD and Jaime Velásquez MD1
Key Words: Carotid artery, Double
This 72 year-old woman presented with a
sudden onset of severe headache and then loss of consciousness. Computed
tomography scanning revealed a subarachnoid haemorrhage (SHA) that
appeared pronounced in the right carotid cistern. Angiography
demonstrated right double carotid –posterior communicating aneurysms
(ﬁg.1). Surgery was preformed on Day 10 post –SHA. The proximal carotid
aneurysm was directed to the temporal lobe and appeared reddish and
fragile with hemosiderin around it.
We thought it was the one that bled. The
second aneurysm was of ventral type and was situated before the origin
of the anterior choroidal artery. Figure 2 shows an intraoperative view
of the lesion with clip application in the proximal aneurysm. The
postoperative course was uneventful and the patient remains
The occurrence of multiple aneurysms has been well described in the
literature; these lesions represent approximately 20% of all
intracranial aneurysms. However, the ﬁnding of more than one aneurysm of
the same artery is rare.1,2,5,6,7,8,9 Kojima and Waga reviewed 356 cases
of cerebral aneurysms. Of the 59 patients with multiple aneurysms, there
were 10 with more than one aneurysms on the same
artery. Thus the incidence was 2.8%. The
from the internal carotid artery in seven patients, from the
middle cerebral artery in two, and from anterior communicating
artery in only one. This entity is so uncommon,
only three articles were found in the literature.We think that in our case the lesion is a complex aneurysm,
with the whole carotid artery involved at the posteriorcommunicating segment. That is, a fusiform carotid
artery with two saccular dilatations, the proximal one wasdirected outward and the distal ventrolaterally.
Special care deserves the surgical technique in these
lesions, we recommend alarge fronto-lateral approach
beginning with arachnoidal dissection from the medial to
lateral side of the perichiasmatic cisterns, leaving the temporal
lobe untouched. Only proximal Sylvian dissection
is needed. First the proximal saccular dilatation that was
fragile and that seemed that had bled was clipped. The fusiform
dilatation with the distal saccular part was wrapped
Another possibility could be a fenestrated clip, but we thought this technique was too dangerous because of
sudden rupture of the ventrolateral part of the aneurysm or
occlusion of the nearby anterior choroidal artery.
Double carotid artery aneurysms are rare, hypertension
seems to have an important role in the development
of this entity. In this case it was a complex aneurysm with
a fusiform and two saccular parts.4
Angiography frequently does not show the
real shapeof the aneurysm and only direct observation at surgery can
proves it. It is important that surgeon keeps in mind all
the probabilities of manouvres available when he or she
suspects it preoperatively. We think that direct clipping of
the saccular part of the aneurysm plus wrapping of the
fusiform dilatation was a safe surgical solution.3
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RV, Jain VK.Association between an aplastic basilar
artery accompanied by a primitive carotid-vertebrobasilaranastomosis, and multiple aneurysms on the
dominant posterior communicating artery J Neurosurg
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technique of multiple aneurysms of the same internal
carotid artery. Acta Neurochir 1978; 41: 23-37.
7. Kojima T, Waga S.: More than one aneurysm on the
same artery. Surg Neurol 1984; 22:403 -408.
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