A 69-year-old woman presented with progressive diplopia and was found to have bilateral ICA aneurysms, 22 x 7 mm at largest. She had stenting of the left ICA aneurysm with improvement of her symptoms and no complications. Five years post procedure, she presented with recurrent diplopia and was found to have enlargement of the previously seen right-sided cavernous ICA aneurysm, which was treated with another flow diversion stent with no complications.

Endoluminal reconstruction/ flow diversion with Pipeline™ Embolization Device has emerged as an alternative to traditional endosaccular coiling and parent artery occlusion. The intent is to treat large, fusiform, or wide-necked aneurysms that are more difficult to treat with conventional methods. Studies revealed that the use of the Pipeline device leads to complete aneurysmal occlusion in 12 months, and a different study reported that flow diversion is more cost effective than coiling for treatment of giant aneurysms. One potential complication associated with the use of flow diversion stents is delayed aneurysm rupture.

We report a case of bilateral cavernous carotid giant aneurysms treated with flow diversion and demonstrate that flow diversion stenting using the Pipeline™ Embolization Device is a safe and reliable treatment for bilateral giant ICA aneurysms. We encourage interventionists to consider this technique in patients with giant intracranial aneurysms.