• Delia Cannizzaro, Simone Peschillo, Cristina Mancarella, Biagia La Pira, Emanuela Rastelli, Emiliano Passacantilli, and Antonio Santoro.
• Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
• J Stroke Cerebrovasc Dis. 2017 Jun 1; 26 (6): e114-e118.

BackgroundIntracranial carotid artery aneurysm can be treated via microsurgical or endovascular techniques. The optimal planning is the result of the careful patient selection through clinical, anatomic, and angiographic analysis.Clinical PresentationWe present a case of ruptured internal carotid artery (ICA) aneurysm that became a complex aneurysm after failure of multi-endovascular and surgery treatment. We describe complete trapping in awake craniotomy after failure of coiling, stenting, and bypassing.ConclusionsICA aneurysms could become complex aneurysms following multi-treatment failure. Endovascular approaches to treat ICA aneurysms include coiling, stenting, flow diverter stenting, and stenting-assisted coiling technique. The role of surgery remains relevant. To avoid severe neurologic deficits, recurrence, and the need of retreatment, a multidisciplinary discussion with experienced endovascular and vascular neurosurgeons is mandatory in such complex cases.Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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