Giant cervical internal carotid artery aneurysm associated with multiple intra- and extracranial aneurysms: a case...

The coexistence of intracranial and extracranial aneurysms is an uncommon association and suggests an underlying systemic aneurysmal disorder that involves complex therapeutic challenges. We report a young patient with multiple intra- and extracranial aneurysms, including a giant, partially thrombosed cervical internal carotid artery aneurysm causing severe hemodynamic compromise and ischemic stroke. The cervical lesion was managed with surgical trapping and aneurysmectomy without cerebral revascularization, resulting in favorable short-term clinical and angiographic outcomes. This case highlights the importance of comprehensive vascular assessment, detailed angiographic and hemodynamic assessment, and individualized decision-making regarding extracranial-intracranial bypass. Careful patient selection and detailed hemodynamic assessment may support aneurysm exclusion without bypass in selected patients with adequate collateral circulation, although long-term surveillance remains essential.