Hybrid treatment for a giant thrombosed aneurysm at the distal posterior cerebral artery: A case report and literature review

Abstract

Giant aneurysms at the distal posterior cerebral artery (PCA) are extremely rare, with only <30 cases previously reported to date. This report presents a partially thrombosed giant aneurysm and discusses the treatment strategy. A 63-year-old man presenting gait disturbance, with 1-year history of an enlarging giant thrombosed PCA (P2) aneurysm, was referred to our department. Preoperative balloon test occlusion revealed the patient’s intolerance to the parent artery occlusion. Therefore, we performed hybrid strategy with occipital artery – radial artery interposition – PCA (P3) bypass via an occipital interhemispheric approach followed by an endovascular internal trapping. Bypass surgery at the P3 segment is challenging, but the bypass followed by parent artery occlusion should be performed in case the patient is intolerant for balloon test occlusion.

Keywords

• Bypass
• Endovascular surgery
• Giant thrombosed aneurysm
• Hybrid treatment
• Posterior artery aneurysm