Symptomatic Carotid Stenosis and Unruptured ACA Aneurysm: Case Report

Kim, Tae Ho; Kwon, O Ki; Lee, Sang Hyung; Han, Dae Hee; Jung, Chun Kee; Kim, Hyun Jib

Abstract

We describe the case of a patient with symptomatic left cervical ICA stenosis and aneurysm of the left distal anterior cerebral artery. She presented with chronic headache and recurrent attack of right hemiparesis, and underwent staged operations. Using the interhemispheric approach, the intracranial aneurysm was clipped, and there was no postoperative neurologic deterioration. Two months later, a carotid endarterectomy was performed. The patient recovered without complications and angiography revealed relief of carotid stenosis and non-visualization of the aneurysm. The coexistence of symptomatic carotid stenosis and an unruptured intracranial aneurysm poses a therapeutic dilemma; correction of significant stenosis of the internal carotid artery may increase the pressure and turbulence to which the aneurysm is subjected, while the intracranial approach to an aneurysm, when blood flow is decreased by carotid stenosis, may also involve increased risk. In view of the theoretical risk of increased blood flow and turbulence after carotid endarterectomy, aneurysm neck clipping followed by this procedure either in a single stage or separate stages seems to be the another safest management strategy.