A Ruptured Aneurysm at the Infraoptic Azygous Anterior Cerebral Artery with the Contralateral Internal Carotid Artery Agenesis Treated by Y-stent Assisted Coil Embolization

Abstract

Infraoptic anterior cerebral artery (ACA) is an extremely rare congenital anomaly. This anomalous artery usually arises from the intradural internal carotid artery (ICA) near the level of the ophthalmic artery (OA) or rarely from the extradural ICA. This anomaly frequently harbors a cerebral aneurysm, and may involve other coexisting vascular anomalies. In the case of this anomaly, surgical treatment of the aneurysm at the proximal ACA or anterior communicating artery (ACoA) may sometimes be difficult, because the veiled proximal ACA by the optic nerve would make proximal control inconvenient and the vertical midline segment of the proximal ACA would frequently form a superiorly directing aneurysm with a relatively high position. We report on an extremely rare case of a ruptured aneurysm at the infraoptic azygous ACA, possibly having an extradural origin, accompanied by contralateral ICA agenesis, and also introduce a feasible method for treatment by Y-stent assisted coil embolization.

A Ruptured Anterior Communicating Artery Aneurysm with Infra-optic Course of the Anterior Cerebral Artery: A Case Report and a Short Review

“…Three cases were treated by coil embolization with a simple technique in two cases and with a stent-assisted technique in one case. 3 , 26 , 27) Ruptured ACoA aneurysms with IOA were frequently (44%) associated with other congenital vessel anomalies ( Table 1 ), 3 – 5 , 9 – 23 , 26 – 28 , 30 , 32 , 34) and the present case was the first one of an IOA aneurysm with an anomalous branching of a RAH from the aneurysm.…”

“…We reviewed 31 cases of ACoA aneurysms with unilateral or bilateral IOA including our case that were treated by surgical clipping or coil embolization from published literatures ( Table 1 ). 3 – 5 , 9 – 34) ACoA aneurysms were accompanied by all patterns of IOA according to the Wong’s classification. As to the surgical approach, 23 of 27 cases of ACoA aneurysms were treated by clipping via a pterional approach and an orbitozygomatic approach.…”

“…7) Alternatively, endovascular treatment of ACoA aneurysms with IOA may be equally feasible depending on their accessibility and morphology, although the importance and limitation of precise detection and preservation of these vessels remain as with surgical treatment. 2 , 3 , 26 , 27 , 39)…”

“…The following words were searched: “infra-optic course of anterior cerebral artery,” “carotid–anterior cerebral anastomosis,” or “anterior cerebral artery anomaly” and “cerebral aneurysm.” As a result, 30 cases of ACoA aneurysms with IOA met the purpose of our review and 31 cases including the present case were analyzed regarding their anatomical features, treatment strategies, and outcomes ( Table 1 ). 3 – 5 , 9 – 34) The mean age of patients was 42.5 ± 14.6 (standard deviation) years old. The right-sided IOA was dominant (right, 22 cases; left, 2 cases; and bilateral, 7 cases).…”

An Unruptured Anterior Communicating Artery Aneurysm with Bilateral Infraoptic Anterior Cerebral Arteries. Case Report and Review of the Literature

“… 11) The anomalous ACA usually arises from the intra-dural ICA near the level of the ophthalmic artery, as it did in the presented case, or rarely from the extra-dural ICA. 9) …”