Embolization of Anterior Communicating Aneurysm associated with Interrupted Aortic Arch

extremity weakness. Brain MRI showed multiple scattered embolic infarctions on left middle cerebral artery (MCA) territory with A-com aneurysm. Transfemoral cerebral angiography was tried and failed due to stenosis of distal aortic arch (Fig. 1). Therefore, cerebral angiography was performed through right radial artery and revealed 3.2×2.5 mm-sized anterior communicating (A-com) aneurysm with interrupted aortic arch (IAA) and complete obliteration of left MCA (Fig. 2A, B). For embolization of A-com aneurysm, it was difficult to access into the tortuous common carotid artery (CCA) via radial artery and transcarotid approach was decided. Under ultrasonographic guidance, direct puncture of the CCA was done using micropuncture needle (Cook, Bloomington, IN) and a .035 hydrophilic guidewire (Terumo, Tokyo, Japan) was navigated into the distal cervical intracranial artery (ICA) under road mapping control. Thereafter, a 5-Fr short sheath introducer (5 cm, St. Jude medical, MN) was carefully advanced into the origin of the left ICA. Once the carotid sheath was placed in position, IV anticoagulation was initiated (a bolus of 5000 IU of heparin and then an immediate infusion of 3000 IU/hr). Next, a 5-Fr Envoy guiding catheter (Cordis, Miami lake, FL) was advanced into the proximal cervical segment of the left ICA and a Prowler microcatheter was navigated into the aneurysm sac. The aneurysm was subsequently embolized with Trufil DCS coils (Cordis, Miami lake, FL). Control angiogram showed successful packing of the aneurysm