Multiple Telescoping Flow Diverter Technique in Endovascular Treatment of a Giant Petrous and Cavernous Carotid Aneurysm

Using flow diverters (FDs) to treat carotid cavernous aneurysms has achieved favorable clinical and radiologic outcomes. However, the treatment of some giant carotid cavernous aneurysms with FDs remains technically challenging. We report the case of a 24-year-old male who presented with headaches and left facial numbness. Magnetic resonance images and angiography revealed a left giant thrombosed dissecting carotid aneurysm with involvement of the petrous and cavernous segments of the carotid artery. Because this giant aneurysm involved a long segment of the parent artery, the multiple telescoping FD technique was used to ensure adequate neck coverage and enhance the flow-diverting effect for endoluminal reconstruction. A new type of FD, the Lattice flow diversion device (AccuMedical, Beijing, China), was used in this case. Five Lattice FDs were successfully deployed in a telescopic fashion to completely cover the aneurysmal segment from the proximal to distal healthy segment. The patient recovered from the procedure without any complications, and his symptoms had completely resolved at the 3-month follow-up. The angiogram taken at 6 months showed complete remodeling of the internal carotid artery with no aneurysmal opacification. This case highlights the effectiveness of the multiple telescoping FD technique in treatment of long-segment giant petrous and cavernous carotid aneurysms. The technical nuances of the procedure and potential advantages of the Lattice FD are illustrated in this video atlas. Informed patient consent for the procedure and for publication was obtained.