Large and tortuous - internal carotid artery aneurysm: endovascular repair

Extracranial internal carotid artery (ICA) aneurysms are a rare entity. There are very few cases reported in the world literature and most of these have been managed by open surgical techniques, which is the gold standard. Endovascular repair of these aneurysms is now an emerging reality in the modern world. We describe our experience of endovascular repair of a large extracranial internal carotid artery aneurysm which was associated with a highly tortuous and kinked artery and was reaching upto the base of skull. We faced several intraoperative challenges which we would like to share and eventually succeeded. We are happy to report an excellent patient outcome with no morbidity and strongly recommend such techniques for the repair of these aneurysms. But more cases need to be done and more data needs to be acquired as regards long term follow up before we can conclusively state that endovascular option for such aneurysms is the preferred modality.