Background and Objectives: Persistent sciatic artery (PSA) is a rare congenital vascular anomaly that is often asymptomatic, but can be associated with aneurysm formation and potential complications, such as thromboembolism or aneurysm rupture in some cases. We present a case of a 75-year-old woman with a symptomatic thrombus-containing aneurysm of the left PSA. Materials and Methods: The treatment of the PSA aneurysm involved a successful hybrid approach, which included open surgical bypass and endovascular embolization. The open surgical bypass was performed from the left common femoral artery to the left above-the-knee popliteal artery using a synthetic graft, while the aneurysm exclusion was achieved through endovascular plug embolization. Results: Control angiography revealed complete exclusion of the PSA aneurysm. At the 1-month follow-up, there were no palpable pulsatile masses in the left gluteal region, and the patient reported no symptoms. Conclusions: Given the high incidence of limb- and life-threatening complications associated with a PSA aneurysm, accurate diagnosis and appropriate treatment are crucial. In this case, a combination of open surgical and endovascular techniques resulted in a favorable outcome for the patient, highlighting the effectiveness of the hybrid approach in managing PSA aneurysms. Further studies are warranted to explore and refine treatment strategies for these complex vascular anomalies.

Background and Objectives: Partially thrombosed aneurysms represent a subset primarily found within large and giant aneurysms. The presence of an intraluminal thrombus can cause an aneurysm to present in different shapes upon angiographic examination. We present a series of five cases of “donut-shaped” aneurysms observed over the past decade at the Clinic for Neurosurgery in the University Clinical Centre of Serbia. Materials and Methods: The management of “donut-shaped” aneurysms was accomplished through endovascular interventions, employing techniques such as the deployment of flow-diverting stents or a combination of stent placement and coil embolization. Results: Four out of five patients underwent endovascular treatment, yielding positive outcomes with complete thrombosis of the aneurysms during follow-up. The fifth patient was successfully diagnosed; however, due to their deteriorating condition, treatment was not feasible. Conclusions: Given the potential life-threatening complications associated with this entity, accurate diagnosis and appropriate management are crucial. In our cohort, endovascular interventions demonstrated efficacy in the majority of cases, underscoring the significance of this approach in treating “donut-shaped” aneurysms. Nevertheless, considering the rarity of this condition, further research is justified to refine diagnostic and therapeutic strategies for these complex intracranial vascular anomalies.

We present a rare case of a 16-year-old male who was admitted with bilateral tinnitus and subsequently underwent magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) for further evaluation. The left internal carotid (ICA) artery had a normal caliber but ended as a stump at the C7 segment, with a network of filiform vessels from both the stump and right posterior communicating artery (PComm). The right PComm was hypertrophic and the right posterior cerebral artery (PCA) was mainly supplied by the right ICA. The right ICA’s bifurcation and the initial middle cerebral artery (MCA) segment were absent, while the MCA trunk was hypoplastic. The right PCA and pial branches vascularized the temporal lobe, with collaterals between the PCA and MCA. The left ICA was slightly enlarged with double fenestration at the left A1 segment. The right A1 segment of the anterior cerebral artery had double fenestration and while several diagnoses were considered, no single diagnosis fully explained all clinical findings. A thorough review of the existing literature yielded no comparable cases, highlighting the uniqueness of this presentation. This case emphasizes the complexity of cerebral vascular anomalies and the challenges associated with diagnosing such rare conditions, underscoring the need for careful assessment.

Background/Objectives: Risk stratification in asymptomatic carotid stenosis has traditionally relied on the degree of luminal narrowing; however, plaque vulnerability may better predict cerebrovascular events. Ipsilateral silent brain lesions (SBLs) are considered surrogate markers of stroke risk. This study aimed to identify carotid plaque features on duplex ultrasound (DUS) and computed tomography angiography (CTA), as well as circulating biomarkers, associated with ipsilateral SBL in patients with clinically asymptomatic ≥70% internal carotid artery stenosis. Methods: This prospective observational study with cross-sectional imaging analysis included 316 clinically asymptomatic patients with ≥70% carotid stenosis treated between January 2022 and October 2024. All patients underwent cranial non-contrast CT for SBL detection, DUS plaque characterization (according to the Gray–Weale classification and plaque surface morphology), and CTA analysis, including plaque surface, composition, length, and attenuation values categorized according to Schroeder’s criteria (120 HU calcified). Demographic, clinical, and laboratory parameters, including inflammatory biomarkers, were recorded. Multivariate logistic regression was performed to identify independent predictors of SBL. Results: SBL were detected in 72 patients (22.8%). On DUS, SBL were significantly associated with Gray–Weale class II plaques, heterogeneous composition, and irregular or ulcerated surfaces (all p < 0.001). On CTA, lipid-rich plaques (<50 HU), ulcerated surfaces, heterogeneous morphology, and lower median plaque density were significantly more frequent in the SBL group (all p < 0.001). In multivariate analysis, independent predictors of SBL were male sex (OR 2.2; 95% CI 1.2–5.7; p = 0.029), Gray–Weale class II plaques (p = 0.002), lipid-rich plaque morphology (OR 21.39; 95% CI 6.86–66.76; p < 0.001), and ulcerated plaque surface on CTA (OR 20.62; 95% CI 7.37–57.68; p < 0.001). Conclusions: Specific ultrasound and CT plaque characteristics were associated with ipsilateral silent brain lesions in patients with asymptomatic ≥70% carotid stenosis. A multiparametric imaging approach may improve risk stratification beyond stenosis severity alone.