Coiling of a residual internal carotid artery aneurysm via an extracranial-intracranial bypass graft following parent vessel occlusion.

We report the case of a ruptured internal carotid artery (ICA) aneurysm that demonstrated significant persistent filling despite management with a common carotid to middle cerebral artery saphenous vein extracranial-intracranial bypass and subsequent permanent ICA balloon occlusion. The residual aneurysm was successfully embolised with detachable coils using a novel endovascular approach via the bypass graft.