Endovascular Coil Embolization of a Ruptured Distal Anterior Choroidal Artery Aneurysm Associated With Ipsilateral Middle Cerebral Artery Occlusion -Case Report-

Abstract

An 84-year-old woman with a history of hypertension and a brain infarction presented with a rare distal anterior choroidal artery (AChoA) aneurysm not associated with moyamoya disease manifesting as sudden onset of headache caused by intraventricular hemorrhage. Digital subtraction angiography revealed a peripheral aneurysm in the left AChoA located distal to the plexal point and steno-occlusive changes of the proximal left middle cerebral artery (MCA) and the left posterior cerebral artery (PCA).Collateral arterial channels to the left MCA and left PCA territories were observed along the left AChoA.No neuroimaging findings were compatible with moyamoya disease. Since the aneurysm did not shrink at 2 months after the onset, endovascular treatment was indicated. Under local anesthesia, a microcatheter was placed into the AChoA proximal to the aneurysm with the aid of a 0.008-inch microguidewire. After a provocation test, three detachable platinum coils were delivered into the aneurysm and the parent artery. Complete obliteration of the aneurysm was achieved without additional neurological sequelae. Successful treatment of a ruptured distal AChoA aneurysm associated with atherosclerotic changes of the intracranial arteries was achieved using a meticulous endovascular technique.

Endovascular therapy of ruptured distal anterior choroidal artery aneurysm associated with moyamoya pattern collateralization secondary to middle cerebral artery occlusion

“…They occluded the aneurysm itself and the distal AChoA without compromise of the moyamoya pattern of collateralization. [7] Although the microcatheter could not be advanced within the aneurysm in the present case, the blood flow of the aneurysm was successfully stopped with the coil embolization of the distal AChoA in as short of a segment as possible. The development of microcatheters and coils will make safe coil embolization of distal aneurysms possible.…”

“…To the best of our knowledge, only three cases of the distal AChoA aneurysm associated with the MCA occlusion have been reported. [7,8] In the literature, most of the patients with ruptured distal AChoA aneurysms underwent an open surgery (clipping or trapping). However, the open surgery is technically challenging because of the difficulty of accurate localization of and clearly exposing the aneurysm due to the deep and narrow operating field, [9] and open surgery is also a more invasive procedure in presence of collateral vessels.…”

“…The development of microcatheters and coils will make safe coil embolization of distal aneurysms possible. Kim et al [14] 2009 43/F IVH Moyamoya disease Glue Stationary Yang et al [3] 2010 56/F Headache Moyamoya disease Glue Good 38/F IVH, headache Moyamoya disease Coil Good Nishida et al [7] 2011 84/F IVH MCA occlusion Coil Fair Dolati et al [4] 2012…”

Rare Distal Anterior Choroidal Artery Aneurysm

“…6 Several reported cases of the distal AChA show that the cases were successfully treated using coils and n-butyl cyanoacrylate (nBCA) liquid embolization, arguing that the endovascular technique is a promising modality for this rare case. [2][3][4][5][6][7][8][9] In conclusion, in the present case, aneurysm of distal choroidal anterior artery can be managed. Timing of surgery with great caution may be an advantage to improve the prognosis of the patient.…”

Ruptured distal anterior choroidal artery aneurysm presenting as isolated intraventricular hemorrhage: Case report and comprehensive review of the literature

“…Since then, many distal AChA aneurysms have been actively managed by a variety of therapeutic modalities. Out of thirty cases reported in the literature, 13 were treated with open microsurgery, [2,4,5,9,11,12,[14][15][16][17][18][19] five through endovascular procedure, [1,[20][21][22]24] and one through an endoscopic approach. [23] With the establishment of microsurgical techniques, surgical clip ligation has been utilized with good outcomes.…”