Delayed spontaneous rupture of cavernous segment of the internal carotid artery following dual ophthalmic segment aneurysms treatment with pipeline embolization device: A case report

RATIONALE: The incidence of double aneurysms on the ophthalmic segment of the internal carotid artery (ICA) is very rare. Nevertheless, delayed rupture of a parent artery instead of the aneurysmal sac following pipeline embolization device (PLED) is unusual. PATIENT CONCERNS: We present a 72-year-old female who was admitted at our facility with gradual onset of nonspecific visual changes. DIAGNOSIS: Conventional angiography revealed 2 aneurysms located at the ophthalmic segment of the left ICA. INTERVENTIONS: Both aneurysms were successfully treated with PLED. OUTCOMES: Two months after discharge, the patient was rushed into the emergency with bilateral conjunctival congestion. Computed tomography revealed intracranial hemorrhage at left temporal lobe while digital subtraction angiography established a left direct carotid cavernous fistula. We utilized stent (Solitaire 6∗30) assisted coils to occlude the fistula. The patient is well and go about her normal duties. LESSIONS: Manipulation of the tortuous parent artery resulted in a focal traumatic weakness in the artery and subsequently a delay tear. We are of the view that, endovascular surgeons should be on the lookout for this complication following flow deviation treatment modalities.