BMJ Case Reports 2018; doi:10.1136/bcr-2018-227020
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Unusual right internal carotid artery supraclinoid segment fenestration associated with multiple aneurysms treated with flow diversion and coiling

  1. Tejinder Pal Singh1
  1. 1Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  2. 2Neurological Imaging and Interventional Sevice of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  1. Correspondence to Dr Nihar Jha, niharjhatn{at}
  • Accepted 22 August 2018
  • Published 10 September 2018


The supraclinoid (carotid-ophthalmic) segment of the internal carotid artery (ICA) under the Bouthillier classification is defined as the segment between the ophthalmic and posterior-communicating arteries.1 We describe an unusual congenital anomaly of the supraclinoid internal carotid artery characterised by a large fenestration of its carotid-ophthalmic segment, associated with multiple aneurysms.

A 60-year-old female patient underwent investigation for persistent headaches and was found to have what appeared to be irregular fusiform dilatation of the intracranial right internal carotid artery on 1.5 T magnetic resonance angiography (MRA) time-of-flight imaging. Cerebral digital subtraction angiography (DSA) performed to further characterise this abnormality demonstrated two discrete aneurysms, one measuring 5 mm and the other 2 mm, arising from the posterior limb of a supraclinoid ICA fenestration (figure 1A).

Figure 1

(A) Three-dimensional reconstruction of a rotational digital subtraction angiogram …

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