Internal Carotid Artery Aneurysms: Four Incidental Paraophthalmic and Supraclinoid Tandem Aneurysms, Treated with a Single Flow-Diverter Stent

Abstract

Tandem aneurysms are rare vascular lesions that denote the presence of two or more aneurysms in close proximity to each other on the same parent vessel. This condition presents unique challenges for treatment, whether via a surgical or an endovascular strategy (John et al., World Neurosurg 107:142–147, 2017; Fang et al., Eur Radiol 26:351–358, 2016). The occurrence of a posterior communicating artery aneurysm together with an ophthalmic segment or a paraclinoid aneurysm is among the most frequently observed combinations of tandem internal carotid artery (ICA) aneurysms. Each lesion requires a different surgical technique, and the mere presence of multiple aneurysms complicates the therapy for each one. This is also partially true for endovascular strategies, where the presence of tandem aneurysms requires additional precautions and probably a longer flow-diverter stent. Traditionally, endovascular management of tandem aneurysms was based on embolization tailored to each aneurysm and requiring multiple catheterizations for the treatment of each one. With this approach, procedural risks are multiplied by the number of aneurysm to be treated. More recent studies have presented encouraging results with the use of a single flow-diverter for the treatment of tandem ICA aneurysms with a high rate of aneurysm exclusion and an acceptable risk profile (John et al., World Neurosurg 107:142–147, 2017; Fang et al., Eur Radiol 26:351–358, 2016; Bhogal et al., Clin Neuroradiol, https://doi.org/10.1007/s00062-018-0723-z). This approach also seems to compare favorably with the multistage approach in terms of cost, procedure time, fluoroscopy time, and radiation exposure (Bhogal et al., Clin Neuroradiol, https://doi.org/10.1007/s00062-018-0723-z, 2018). The presented case supports previous observations on the safety and effectiveness of the implantation of single flow-diverter stent for the management tandem ICA aneurysms.