Treatment of ruptured internal carotid artery trunk aneurysms: Feasibility of endovascular trapping or proximal obliteration of the ICA

ObjectiveRuptured aneurysms arising from non-branching sites of the internal carotid artery (ICA) are often difficult to treat by neck clipping or endosaccular coiling. We discuss the feasibility of simple endovascular ICA ligation or trapping to treat aneurysms.MethodsData from eleven patients were retrospectively analyzed regarding Hunt and Hess grade on admission, angiographic collateral capacities during digital carotid compression, results of balloon test occlusion of the ipsilateral ICA, type of treatment, and Glasgow outcome scale at discharge.ResultsFirst endovascular treatments were performed by day 5 in four cases. Two patients with good clinical grade and good collateral capacity underwent endovascular ICA trapping in the acute stage and showed good outcomes. Two patients displaying poor clinical grade but good collaterals underwent endosaccular embolization. These aneurysms recurred later and the ICAs were trapped by coils in the chronic stage. Four cases underwent first endovascular treatments in the chronic stage. Three patients with good collaterals underwent endovascular ICA trapping or ligation and showed favorable outcomes.ConclusionsSeven of eleven patients could be treated by endovascular ICA trapping or ligation, which offers a simple, safe method for ruptured ICA trunk aneurysms, if collateral capacity is good and neurological condition is not serious.