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Internal carotid artery (ICA) endovascular proximal occlusion and trapping with radial artery grafting is a favorable option in treating giant aneurysms in the cavernous portion of the ICA. Even if ischemic tolerance is proven with the balloon test occlusion (BTO) procedure, treatment strategies will likely vary depending on the individual case. Should other aneurysms exist in collateral vessels, hemodynamic stress will occur on the collateral vessels and the aneurysm after the endovascular proximal occlusion, likely causing the aneurysm to enlarge. In such cases, neck clipping of these peripheral aneurysms should be performed before ICA proximal occlusion or trapping and vascular bypass.

The Strategy of Treatment for Co-existing Aneurysm after Proximal Parent Artery Occlusion of Symptomatic Large Cavernous Portion ICA Aneurysm