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Internal carotid artery (ICA) trapping+radial artery graft could be performed for ICA cavernous, paraclinoid portion aneurysms. Direct clipping procedures are not always possible to carry out in these cases, because there are a lot of neurostructures surrounding aneurysms. These nerve structures could be easily damaged during the direct clipping procedure. Compared with direct clipping procedure, ICA trapping+radial artery graft could be a safe and easy method to achieve intra-aneurysm thrombosis and neurological improvement. However, treatment strategy may differ among nonbleeding and bleeding cases. Endovascular proximal occlusion is the first choice for nonbleeding cases who mainly suffered from ophthalmoparesis. But it is important to estimate ischemic tolerance before permanent proximal occlusion by balloon occlusion test (BOT). ICA trapping+radial artery graft should be selected in cases without ischemic tolerance for BOT. On the other hand, ICA trapping + radial artery graft should be primarily performed for patients with ruptured anterior wall ICA aneurysms without the BOT procedure, because re-bleeding may occur during the BOT procedure.