The supraclinoid ICA fenestration (SIF) is considered an extremely rare congenital anomaly. However, most of the reported cases of SIF are associated with intracranial aneurysms either ruptured or unruptured. We report the case of a 55-year-old patient with a right SIF and an unruptured, large, wide-necked aneurysm located on the larger limb of the fenestration and a second small aneurysm distal to the SIF. The aneurysms were treated with a Pipeline flow-diverter stent, achieving the complete reconstruction of the anatomy of the carotid siphon. The literature concerning these peculiar anatomic conditions has been reviewed, allowing discussion about treatment of such associated lesions.
Keywords: Aneurysm; Carotid; Fenestration; Flow diverter; Pipeline; Supraclinoid.