Endovascular Reconstruction Utilizing Flow Diversion Stenting in a Patient With Bilateral Giant Cavernous Internal Carotid Artery Aneurysms

Bilateral giant cerebral aneurysms are exceedingly rare. Giant aneurysms of the internal carotid artery (ICA) carry a poor prognosis if untreated. Flow diversion is an endovascular technique whereby a device is placed in the parent blood vessel to divert blood flow away from the aneurysm and is an available treatment for giant aneurysms. A 69-year-old woman presented with progressive diplopia and was found to have bilateral ICA aneurysms. She had stenting of the left ICA aneurysm with improvement of her symptoms and no complications. Five years post procedure, she presented with recurrent diplopia and was found to have enlargement of the previously seen right-sided cavernous ICA aneurysm, which was treated with another flow diversion stent with no complications. Endoluminal reconstruction/flow diversion with Pipeline™ Embolization Device (PED) has emerged as an alternative to traditional endosaccular coiling and parent artery occlusion. We report a case of bilateral cavernous carotid giant aneurysms treated with flow diversion and demonstrate that flow diversion stenting using the PED is a safe and reliable treatment for bilateral giant ICA aneurysms. We encourage interventionists to consider this technique in patients with giant intracranial aneurysms. J Neurol Res. 2020;10(4):136-139 doi: https://doi.org/10.14740/jnr593