Cross-Circulation Thrombectomy for Acute Middle Cerebral Artery Occlusion from Dislodged Thrombus of a Giant Internal Carotid Aneurysm: A Case Report.

Objective: Giant aneurysms of the cavernous segment of the internal carotid artery presenting as acute ischemic stroke (AIS) are rare and often misdiagnosed. Limited treatment experience further complicates management.

Case presentation: A 70-year-old female presented with acute right middle cerebral artery (MCA) occlusion due to a dislodged thrombus from a giant internal carotid aneurysm. Emergency multimodal brain imaging techniques, including CT, CTA, and DSA, were used to clarify the diagnosis. Given the giant aneurysm's interference, cross-circulation thrombectomy via the anterior communicating artery was performed to revascularize the occluded artery. The patient achieved a relatively good outcome due to timely reperfusion.

Conclusion: This case highlights the importance of advanced imaging and innovative surgical techniques in managing complex cerebrovascular conditions, offering insights for future treatment of giant intracranial aneurysms with cerebral embolization.