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Because of a high tendency toward rebleeding, we treat all ruptured aneurysms of the anterior wall of the supraclinoid internal carotid artery (ICA) with trapping of the rupture site through vascular reconstruction of the distal internal carotid artery. However, according to the site and size of a ruptured aneurysm, some patients are treated with trapping of the posterior communicating artery (PCoA) or proximal clipping of the ICA to create a blind end. We reviewed and analyzed the clinical records of 12 patients treated between 2009 and 2015 at our hospital. We divided aneurysm locations into 3 types. Four patients with an aneurysm located between the origin of the ophthalmic artery and PCoA (Type 1) were treated with trapping between the cervical ICA and the ICA distal to the aneurysm. Four patients with an aneurysm located on the opposite wall at the origin of the PCoA (Type 2) were treated with trapping that included the origin of an adult type PCoA. Among 4 patients with an aneurysm located distal to the PCoA (Type 3), 2 were treated with clipping of the ICA proximal to the PCoA, and 2 were treated with direct fenestrated clipping. Only 1 patient (Type 3) had a postoperative ischemic complication. In conclusion, surgical outcomes of bypass and trapping for treating ruptured anterior wall ICA aneurysms were favorable, but the management of Type 3 aneurysms remains challenging.

Management of Ruptured Anterior Wall Aneurysm of the Internal Carotid Artery with High-flow Bypass Using a Radial Artery Graft