Combined open and endovascular treatment of a saccular aneurysm and redundant loop of the internal carotid artery

We report the unusual case of a woman with a saccular aneurysm of the distal cervical internal carotid artery arising just distal to a kink and a 360° redundant loop. The retromandibular position of the aneurysm would have mandated a complex surgical procedure. A purely endovascular approach was not possible owing to the difficulty to pass any kind of device beyond the redundant loop. A hybrid approach, in which the kink was surgically straightened and the saccular aneurysm coiled after stenting of its orifice, was therefore used to treat this challenging case. A review of the literature supporting this approach is discussed.