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Fig 1. A, A large extra-axial lesion and hemorrhagic component indicative of a giant thrombosed aneurysm is apparent in the basal ganglia on the coronal T1-weighted MR image. B, Selective DSA of the right internal carotid artery before treatment reveals a patent portion of the giant thrombosed aneurysm. C, Selective DSA after embolization reveals complete occlusion of the aneurysm and a patent internal carotid artery–external carotid artery bypass. D, Follow-up 3D TOF MRA with MIP reconstruction performed at 1 year after treatment is inconclusive because of artifact related to the methemoglobin component of the thrombosed aneurysm. Additionally, flow-related signal intensity loss in the A1 segment of the anterior cerebral artery is apparent. E, Conversely, follow-up CE-MRA with MIP reconstruction demonstrates both the patent internal carotid artery–external carotid artery bypass and the presence of a small (type I) remnant at the neck of the treated aneurysm.
