Introduction: Mirror aneurysms of the pericallosal artery are extremely rare and pose unique challenges
for both neurosurgical and endovascular management. We report a case of hybrid treatment combining
microsurgical clipping and endovascular coiling for bilateral distal anterior cerebral artery (DACA)
aneurysms, with an anatomical, technical, and strategic discussion based on current literature.
Case report: A 72-year-old male patient with two unruptured pericallosal artery aneurysms underwent
staged treatment: microsurgical clipping of the dominant lesion followed by endovascular embolization
of the contralateral aneurysm. The left-sided aneurysm (6 mm) was successfully clipped. The right-sided
lesion (3 mm), with a calcified neck, was treated endovascularly 30 days after the initial procedure. The
patient remained neurologically intact.
Discussion: Even small distal ACA aneurysms carry a high risk of rupture and require individualized
therapeutic planning. The combination of techniques—clipping for high-risk lesions and coiling for
technically unfavorable configurations—offers an effective and safe strategy, especially when performed
by a multidisciplinary team in hybrid-capable centers.
Conclusion: Hybrid strategies prove effective in selected cases of distal mirror aneurysms.
Multidisciplinary, individualized assessment based on vascular anatomy and technical risk is essential
for optimal outcomes.
