Visual Impairment due to a large paraclinoid aneurysm treated with parent artery occlusion and bypass: A case report

Yuya Kato, Naoto Kimura, Hidenori Endo, Youhei Takeuchi, Michiko Yokosawa, Takayuki Sugawara, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review


Introduction: Paraclinoid internal carotid artery (ICA) aneurysms can sometimes cause visual field disturbances due to their size, and it is challenging to treat either surgically or using endovascular techniques. Flow diverters generally have positive outcomes, but sometimes in symptomatic aneurysms, we see the thrombosed section becomes enlarged. Therefore, optimal treatment strategies are difficult to determine. Case: A 68-year-old woman presented with a chief complaint of vision loss in the left eye. A large wide-necked saccular aneurysm was found on the left ICA paraclinoid portion. Under general anesthesia, a Pipeline Flex was inserted along with coil embolization. After treatment, the aneurysm showed thrombotic expansion, and the visual impairment worsened. One year later, aneurysm recanalization was evident; therefore, another Pipeline was inserted to overlap the stent. However, her visual impairment worsened again, and parent artery occlusion with high flow bypass was performed 20 months after her first treatment. Two weeks postoperatively, improved peripheral vision was confirmed. Further, no enlargement of the aneurysm was observed using magnetic resonance imaging 6 months later. Conclusion: This case examined a symptomatic, large paraclinoid aneurysm in a patient, which continued to enlarge after Pipeline stent placement, but was later treated successfully using direct parent artery occlusion in combination with high-flow bypass.

Original languageEnglish
Article number106280
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number4
Publication statusPublished - 2022 Apr
Externally publishedYes


  • Flow diverter
  • High-flow bypass
  • Paraclinoid aneurysm
  • Parent artery occlusion

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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