Direct cervical internal carotid access for GDC treatment of an ophthalmicorigin carotid aneurysm

The use of detachable coils in the treatment of intracranial aneurysms cont inues to evolve since its introduction in 1991 [1-5]. Although not well des cribed in the literature, technical considerations in gaining and maintaini ng access to intracranial aneurysms play a pivotal role in any successful e ndovascular treatment. Tortuosity and looping of the cervical internal caro tid artery (ICA) is one problem occasionally encountered. These unusual loo ps, in addition to the normal turns of the carotid siphon result in less co ntrol of the microcatheter tip. This problem culminated in this case where an ophthalmic origin carotid aneurysm could not be successfully treated fro m the standard femoral approach due to the presence of multiple ICA turns, with the presence of a proximal cervical ICA turn being particularly bother some. This problem was circumvented by use of direct surgical access to the cervical ICA above the cervical ICA turn, allowing for successful endovasc ular aneurysm treatment with detachable coils. (C) 1999 by Elsevier Science Inc.