Introduction Endovascular coil embolization has been effective for cerebral aneurysms since its inception; however, compared with surgical clipping, recanalization remains a concern after coiling. Significant recanalization often necessitates retreatment by re‐coiling or clipping. Established predictors include large/giant size, wide neck, ruptured status, and partial thrombosis. Migration or compaction of coils into intraluminal thrombus can further promote delayed recanalization. Purpose To present a case of recanalization of a partially thrombosed giant ACOM aneurysm after coiling. Methods Patient was encountered during routine clinical practice. Results A 64‐year‐old right‐handed man, heavy smoker and alcohol user with hypertension, presented with new‐onset generalized tonic‐clonic seizure. Brain MRI/MRA demonstrated a giant (3.5 × 2.4 × 3.0 cm) Anterior communicating (ACOM) artery aneurysm with substantial neck filling (17 × 8 × 6 mm) and partial thrombosis. The patient underwent stent‐assisted coil embolization of the aneurysm. At 6‐month follow‐up, diagnostic angiography revealed neck recanalization attributed to flow‐related coil migration into the partially thrombosed sac. He subsequently underwent additional embolization with a Pipeline Flex flow‐diverting stent. Conclusion Patients should be followed by a neurointerventional specialist after coiling to enable early detection of complications. Recanalization should be anticipated in giant, wide‐necked, ruptured, or partially thrombosed aneurysms. Complex intra‐aneurysmal flow and coil migration into mural thrombus can drive recurrence; in such settings, definitive flow diversion may be required at recurrence or considered in initial planning. image

PurposeTo assess the diagnostic value of silent MRA in the follow-up of intracranial aneurysms (IA) post-endovascular treatment.MethodsFrom March 2023 to March 2024, we retrospectively collected data on patients with IA who underwent endovascular intervention and received silent MRA follow-up. All images were anonymized and evaluated on a 5-point scale: 1 (not visible, strong artifacts); 2 (poor quality, numerous artifacts/blurring); 3 (acceptable quality, moderate artifacts/blurring); 4 (good quality, minor blur artifacts); 5 (very good quality, nearly equal to DSA). The quality and occlusion status of aneurysms were descriptively analyzed.ResultsA total of 451 patients with 475 IA treated at our hospital received silent MRA follow-up. The silent MRA showed 100% 5-point scores in the coil embolization group. In the stent-assisted group, 65.7% achieved a 5-point score, and in the flow-diverter (FD) group, 42.6%. The multiple telescopic stents group had only 7.1% with a 5-point score, while the intrasaccular flow disruption group had 55.6%, and the FD+ coil group had 40.7%. There were two cases of distal aneurysms: one A3 segment aneurysm scored 5 points on silent MRA while the other M3 segment aneurysm did not visualize the aneurysm artery. A ≥3 score was helpful for diagnosing postoperative recurrence, with rates of 100%, 97.8%, 87.9%, 57.1%, 88.9%, 85.2%, and 50% across the groups.ConclusionsSilent MRA shows significant potential for postoperative follow-up in endovascular therapy of aneurysms, particularly in interventions of coiling embolization, stent-assisted coiling, and FD.

This study proposes a novel data-driven framework for rapid and accurate prediction of unsteady hemodynamics in a patient-specific cardiovascular model, based on a Deep Learning-based Reduced-Order Model (DL-ROM). High-fidelity simulations of pulsatile blood flow were used to generate a wall shear stress (WSS) dataset. To reduce dimensionality while preserving essential dynamics, Dynamic Mode Decomposition (DMD) was employed, capturing dominant spatiotemporal modes linked to flow instabilities and coherent structures. The extracted DMD time coefficients were then used to train an attention-augmented Convolutional Neural Network with a Long Short-Term Memory layer, enabling the prediction of temporal WSS evolution. The DL-ROM accurately reconstructs high-resolution flow fields at unseen time points, achieving pointwise relative errors below 3% across most of the aneurysm surface. Compared to traditional full-order models, the proposed approach offers over two orders of magnitude reduction in computational cost, supporting near real-time inference. Analysis of DMD mode components further revealed region-specific flow dynamics, with high-frequency oscillations concentrated near the aneurysm dome. This work introduces an efficient and interpretable surrogate model for transient hemodynamic analysis, with promising implications for clinical applications such as rupture risk stratification, fast patient screening, and future integration across multiple aneurysm geometries.

Arterial aneurysms are vascular conditions associated with life-threatening consequences in patients, such as dissection and rupture. Understanding their genetic basis is an evolving field, driven by the robust reporting of genetic variants associated with aneurysms in patients. In this study, we present clinical and genetic data from nine unrelated subjects with arterial aneurysms who were identified to harbor rare variants in the TNXB gene, mainly affecting fibronectin type III (FNIII) domains. The cohort included three female and six male subjects with a mean age of 53.5 years (SD = 14.4). The most frequently affected vascular territory was the thoracic ascending aorta (n = 7). A range of pathogenic impacts was predicted via multiple in silico tools that analyze evolutionary conservation and biochemical properties. Computational protein structure modeling with AlphaFold 3 predicted domain-specific alterations across multiple FNIII regions for four unique missense variants and one in-frame deletion, and premature protein truncation resulting from two frameshift variants. To our knowledge, this study is one of the first and largest to associate TNXB variants with arterial aneurysmal disease. Our findings demonstrate the potential of computational genomics and structural modeling to advance the understanding of extracellular matrix gene alterations in aneurysm pathogenesis.

The authors discuss the history of carotid disease and injuries and focus on historical milestones of carotid endarterectomy worldwide and in Bohemia. The first part discusses the carotid artery and ischemic stroke, beginning with Hippocrates' description of apoplexy. It then highlights Willis's discovery of the collateral circulation, followed by the 19th-century thromboembolic theory of ischemic stroke caused by carotid artery occlusion, which is associated with the work of Wirchow and Chiari. Then, in the 1950s, C. M. Fisher visionarily pointed out the possible surgical management of carotid stenosis in the prevention of stroke. In the second part, carotid ligature, treatments for arterial injuries are mentioned, starting with A. Paré in 1552, to ligature of the extracranial carotid artery for intracranial aneurysm by V. Horsley in 1885. The third part describes the history of reconstructive carotid surgery, especially carotid endarterectomy worldwide, with the priorities of Carrea, Eastcott and DeBakey in the early 1950s. The priority in Bohemia belongs to Jaroslav Lhotka, who published his results in 1962. The authors summarize the history of carotid disease, especially carotid endarterectomy, worldwide and in Bohemia.

Hemodynamics factors influenced by blood flow significantly affect aneurysms growth and rupture. While most studies focus on the temporal effects of blood flow, the potential impact of non-local spatial effects is often overlooked. However, previous research suggests that jet flow from proximal stenosis can lead to long-range (non-local) redistribution of wall shear stress at aneurysm initiation sites. This study employs a non-local spatial fractional derivative non-Newtonian fluid model to characterize the pseudoplastic behavior of blood and analyze flow in stenosis and aneurysmal arteries. Results show that the fractional derivative order (non-local parameter) can serve as an index to characterize cholesterol-rich blood in clinical diagnostics. Strong shear-thinning property of blood characterized by higher-order fractional derivative model reduces viscosity under high shear rates, leading to accelerated blood flow and increased wall shear stress. Subsequently, the increasement of wall shear stress gradient in regions of vascular stenosis and aneurysms, potentially raises the risk of aneurysm rupture in degenerated aneurysm walls.

Differences in Arterial Events in Vascular Ehlers-Danlos, Loeys-Dietz, and Marfan Syndrome.

Abstract Thread injection is a promising way for embedding clinical inserts inside the human body with minimal careful injury, which rouses the exploration of thread annular flow. The permeable thread is wound onto a spool and then injected into an arterial segment utilizing a pressure gradient. The infusion technique should be smooth, and lateral thread deviations ought to stay away from it. A mathematical analysis of the surgical approach for injecting catheters via a stenotic aneurysmal artery is the subject of this research. Medicated antimicrobial agents are characterized by hybrid nanoparticles, and the blood is treated as a fractional second‐grade fluid. Governing equations are formulated in the cylindrical polar coordinates along with boundary conditions. Limiting to the mild disease case, the issue is expressed in the form of a variation of the eccentricity parameter by a perturbation expansion. Our findings indicate that the axial velocity changes conversely along the catheter radius, eccentricity, and relaxation time. Axial velocity for the aneurysmal segment is higher than that of the stenosis segment. Contrary behavior of shear stress is observed on arterial and catheter walls. Moreover, the resistance impedance in the aneurysmal section is lower as compared to the stenotic segment. By exploring the use of medicated antimicrobial agents with eccentric catheter injection and fractional modeling, this investigation has the potential to transform the treatment of various vascular and cardiovascular conditions, leading to improved patient outcomes.

Hypothenar hammer syndrome (HHS) is a post-traumatic change of ulnar artery in the hypothenar region. HHS is a rarely occurring disease and little known among doctors which makes its diagnosis difficult. The authors of this article presented here a clinical case of HHS among the Kazakh population. This clinical case of HHS is the first known in Kazakhstan, so we present it due to it’s exclusivity. The optimal treatment of a such complication of hypothenar hammer syndrome like an aneurism of ulnar artery is surgical. The surgical removement of aneurism usually does not cause relapse or serious complications.Key words: hypothenar hammer syndrome, ulnar artery aneurism, ulnar artery aneurism removal, microsurgery, hand surgery.Сorresponding author: Assel Kaliyeva, Orthopaedic surgeon, PhD-student at theAstana medical university, Astana, Kazakhstan Postal code: Z10H8P3 Address: Kazakhstan, Astana, Beibitshilik street, 49/A Phone: +7 7058563982 E-mail: asselkyz@gmail.comJ Trauma Ortho Kaz 76 (1) 2025: 37-40Recieved: 24-01-2025Accepted: 09-03-2025 This work is licensed under a Creative Commons Attribution 4.0 International License

Gastroduodenal artery (GDA) aneurysm is a rare surgical entity that causes various symptoms. In thecase of rupture, it usually presents an ominous prognosis and mortality rate of up to 40%. Although opensurgical procedure is a mainstay, endovascular intervention is emerging a promising treatment in recentyears, due to its advantages and safety. We present a case of upper gastrointestinal bleeding caused byruptured GDA pseudoaneurysmin a 71-year-old woman, with medical episodes of acute pancreatitis, apancreatic body tumor removal surgery was performed, and now the tumor is relapsing and metastasizing.The treatment approach is blocking off the pseudoaneurysm by a covered stent. The procedure wassuccessful and the patient is asymptomatic. Two months later, the pseudoaneurysm reduces its size andcompletely excluded from the preservation of the blood flow in the artery.Follow-up to 26 month, patient iswell, no symptoms or recurrence. Endovascular interventional treatment in the case of GDA aneurysmsis considered a promising alternative not only to open surgery but also to an effective emerging techniqueeven in the acute setting.Keywords: Gastroduodenal artery - Covered stent - Aneurysm

Introduction: Spinal aneurysms (SAs) are rare and only a few cases are reported. The exact etiology of their formation is still unknown.Methods: We reviewed the literature looking for cases of isolated spinal artery aneurysms (ANs) and, in particular, those involving the anterior arterial group of the spinal cord.Results: Our literature research allowed us to find, to date, 94 publications reporting 131 cases of isolated spinal artery ANs. Data available about these cases are reported and analyzed in the first part of this work. We then presented a new case: A 65‐year‐old female presented with headache and backache. She was subjected to radiological tests documenting the presence of cerebral subarachnoid hemorrhage (SAH) with focal blood collection at the D8–D9 level. The spinal angiography showed an AN of the anterior radicular medullary artery (ARMA). A conservative therapeutic strategy was decided, and the patient was discharged from the hospital in good general condition.Discussion: SAs can be divided into different types depending on the presence of arteriovenous malformations (AVMs) and on their location at the level of the spinal arteries. The clinical presentation is variable, including acute and rapidly progressing symptoms caused by hemorrhage or neurological deficits due to mass effect of hematoma, AN, AVMs, or arteriovenous fistulas (AVFs). The outcome correlates with the clinic and, therefore, with the severity of the specific case.Conclusion: We report a rare case of ARMA AN underlining how this entity is often misunderstood, and therefore, it is important to consider them in the differential diagnosis of spinal lesions. We believe that future studies will be important in order to learn more about the natural history and to characterize the appropriate therapeutic strategies of SAs.

Pressure gradient influence on magnetohydrodynamic (MHD) flow of blood‐based hybrid nanofluid containing gold and copper nanoparticles is investigated in the present study. We adopted Caputo’s definition of fractional derivative to transform time‐varying terms in governing equations after being appropriately normalized. Partial‐analytical solutions of these equations are then numerically sought via the concentrated matrix exponential (CME) method, since complex forms of modified Bessel functions are contained in the normalized equations whose inverse Laplace transforms cannot easily be accomplished using known analytical schemes, which is the overriding novelty of this study. Results for velocity, temperature, and concentration profiles are analyzed graphically. Numerical results for skin friction, Nusselt, and Sherwood numbers are also presented in a table. Our results revealed that the fractional‐order derivative increases velocity, temperature, skin friction, and Sherwood’s number, while concentration and Nusselt’s number decrease, accounting for its memory effects in the behavior of the fluid. Additionally, we observed that blood velocity declines with magnetic parameter values, while temperature distribution increases with Eckert’s number values. The study also shows fluctuations in flow motion, temperature, concentration, skin friction, and Nusselt’s number with the stenosis/aneurysmal height. Overall, our findings have significant implications for targeted drug delivery in the arterial system, especially concerning the treatment of atherosclerosis, aneurysms, and other cardiovascular diseases.

Recent studies have explored the impact of personality traits, including mood swings, on physical health. However, it remains unclear whether there is a direct cause-and-effect link between mood swings and cardiovascular diseases (CVDs). A STROBE-compliant cross-sectional observational study was conducted and analyzed using a two-sample Mendelian randomization (MR) approach to examine the potential causal relationship between mood swings and a range of CVDs, such as arrhythmia, artery aneurysm, coronary heart disease (CHD), heart failure, hypertension, stroke, ischemic stroke, and peripheral artery disease. We sourced genome-wide association studies (GWAS) summary data for mood swings from the UK Biobank, and for CVDs from the GWAS Catalog and FinnGen databases. We excluded single-nucleotide polymorphisms (SNPs) linked to potential confounders such as obesity, smoking, sex, diabetes, as well as SNPs suspected of horizontal pleiotropy, as identified by MR-PRESSO and the MR-pleiotropy method, prior to the final analysis. Sensitivity analyses were conducted using the MR-Egger, inverse variance weighted, and leave-one-out methods. After screening, 57 SNPs were identified as instrumental variables for mood swings, and 9 SNPs related to confounding factors were excluded. An increase in mood swing frequency is correlated with a significant increase in the likelihood of various conditions. Notably, arrhythmia in the FinnGen dataset showed an odds ratio (OR: 2.28, 95% confidence interval [CI]: 1.44-3.61, P < .001), and atrial fibrillation had an OR (OR: 2.25, 95% CI: 1.23-4.11, P = .01). CHD risk was elevated in both the IEU OpenGWAS project (OR: 2.05, 95% CI: 1.30-3.21, P < .001) and GWAS Catalog (OR: 4.45, 95% CI: 1.75-11.33, P < .001). Increased risks were also noted for heart failure (GWAS Catalog: OR: 1.75, 95% CI: 1.09-2.83, P = .02) and hypertension (FinnGen: OR, 2.17; 95% CI: 1.47-3.19, P < .001). However, no significant associations were found for conditions such as arterial aneurysms or ischemic stroke. In combined analyses, mood swings were associated with a higher risk of CHD (OR: 2.21, 95% CI: 1.64-2.97, P < .01), heart failure (OR: 1.74, 95% CI: 1.21-2.50, P < .01), and other CVDs. This study revealed a causal link between mood swings and various CVDs, highlighting intriguing findings. This suggests that implementing proper psychological interventions to stabilize mood may be beneficial for preventing negative cardiovascular events.

Takayasu's arteritis (TA) is a rare, chronic inflammatory disease of unknown cause, primarily affecting young women in their reproductive years. It can result in the narrowing and occlusion of arteries and the formation of aneurysms in arteries, especially those related to the aorta, creating significant risks during pregnancy. Women with TA are more susceptible to cardiovascular complications, including hypertension and heart failure, which can negatively affect both maternal and fetal health. This case report details a 23-year-old pregnant woman diagnosed with TA during the first trimester, presenting with symptoms of fainting and pulselessness in her right upperlimb. Doppler imaging of the right upper limb confirmed the diagnosis. Treatment for TA was initiated alongside comprehensive antenatal care. In the third trimester, she also developed gestational hypertension. And at 36 weeks of gestation, due to placenta previa and preterm premature rupture of membranes, an emergency cesarean section was performed. Timely medical intervention resulted in a favorable outcome, with an uneventful postpartum recovery. This case highlights the need for early diagnosis and collaborative care in pregnant women with TA to ensure better outcomes for both mother and child. Understanding the clinical aspects of TA is essential for effective management and improved prognosis.

Two indices, indicating the regional average stiffness and the pace of strain hardening respectively, are derived from the nonlinear stress-strain behavior obtained from biomechanical analysis of aneurysm. A comprehensive method based on electrocardiographic-gated multidimensional dynamic computed tomography angiography (MD CTA) is developed for extracting these mechanical characteristics in vivo. The proposed indices are evaluated by 26 cases including 9 healthy, one aortosclerosis, and 16 abdominal aortic aneurysm cases. The difference of SSI and dSSI value between aneurysmal and healthy groups is up to orders in magnitude. Significant correlation of these indices with the clinical indicator of aneurysm diameter is found. Logistic models based on these indices are capable to sharply discriminate the healthy and the aneurysmal arteries with AUC>0.98. This work introduces new tools and new indices for aortic mechanical assessment which may shed light on understanding the mechanical condition, pathological state and eventually benefit clinical decision-making.

HighlightsThe article presents a clinical case of successful treatment of a patient with aortic root aneurysm and pulmonary artery stenosis after radical three-stage repair of pulmonary atresia with ventricular septal defect. Abstract Aortic root aneurysm with aortic regurgitation is a rare cause of re-operation in patients who have had primary repair of pulmonary atresia with ventricular septal defect or tetralogy of Fallot. Recently, due to an increase in cases of primary radical treatment of congenital cardiac surgery and life expectancy of these patients, the number of cases of re-operation due to aortic root dilatation has also increased. One of the main reasons for long-term aortic regurgitation and of aortic root enlargement is the presence of a subaortic ventricular septal defect below the aortic valve, which deforms the aortic annulus geometry and changes intra-aortic hemodynamics. All of these factors make the aortic root surgical reconstruction just a question of time. This is a real challenge for both adult and pediatric heart surgeons, requiring a team approach. This article presents a clinical case of successful treatment of a patient with aortic root aneurysm, aortic regurgitation with concomitant pulmonary conduit restenosis and residual ventricular septal defect who underwent a three-stage repair of pulmonary atresia and ventricular septal defect.

The comparative effect of serial stenosis and aneurysms arteries on blood flow is examined to identify atherosclerotic diseases. The finite element approach has been used to solve the continuity, momentum, and Oldroyd-B partial differential equations to analyze the blood flow. Newtonian and non-Newtonian both cases are taken for the viscoelastic response of blood. In this study, the impact of multiple stenotic and aneurysmal arteries on blood flow have been studied to determine the severity of atherosclerosis diseases through the analysis of blood behavior. The novel aspect of the study is its assessment of the severity of atherosclerotic disorders for the occurrence of serial stenosis and aneurysm simultaneously in the blood vessel wall in each of the four cases. The maximum abnormal arterial blood flow effect is found for the presence of serial stenoses compared to aneurysms which refers to the severity of atherosclerosis. At the hub of stenosis, the blood velocity magnitude and wall shear stress (WSS) are higher, whereas the arterial wall normal gradient values are lower. For all cases, the contrary results are observed at the hub of the aneurysmal model. The blood flow has been affected significantly by the increases in Reynolds number for both models. The influence of stenotic and aneurysmal arteries on blood flow is graphically illustrated in terms of the velocity profile, pressure distribution, and WSS. Medical experts may use this study's findings to assess the severity of cardiovascular diseases.

Numerous studies have evaluated the effects of hemodynamic parameters on aneurysm formation. However, the reasons why aneurysms do not initiate in intracranial arteries are still unclear. This study aimed to investigate the influence of hemodynamic parameters, wall shear stress (WSS) and strain, on aneurysm formation by comparing between aneurysmal and non-aneurysmal arteries. Fifty-eight patients with paraclinoid aneurysms on one side were enrolled. Based on magnetic resonance angiography, each patient’s left and right internal carotid arteries (ICAs) were reconstructed. For a patient having an aneurysm on one side, the ICA with the paraclinoid aneurysm was defined as the aneurysmal artery after eliminating the aneurysm, whereas the opposite ICA without aneurysm was defined as the non-aneurysmal artery. Computational fluid dynamics and fluid-structure interaction analyses were then performed for both aneurysmal and non-aneurysmal arteries. Finally, the relationship between high hemodynamic parameters and aneurysm location was investigated. For aneurysmal arteries, high WSS and strain locations were well-matched with the aneurysm formation site. Also, considerable correlations between high WSS and strain locations were observed. However, there was no significant relationship between high hemodynamic parameters and aneurysm formation for non-aneurysmal arteries. The findings are helpful for understanding aneurysm formation mechanism and encouraging further relevant research.

Abstract Introduction Coronary aneurysms are a well-documented complication of childhood Kawasaki disease. They may persist into adulthood predisposing to impaired myocardial blood flow, symptoms, and adverse cardiovascular events. Preliminary reports suggest that Kawasaki disease may also be associated with coronary microvascular dysfunction. The effect of coronary involvement from Kawasaki disease on myocardial perfusion in convalescent asymptomatic adults has not been studied using fully automated inline quantitative perfusion MRI (CMR). Purpose To assess the effect of coronary artery abnormalities on quantitative myocardial perfusion in adult patients with convalescent Kawasaki disease compared to an age and sex-matched control cohort. Methods Retrospective single centre cohort analysis of adult patients with convalescent Kawasaki disease who have undergone fully automated inline quantitative myocardial stress perfusion CMR. All patients had coronary involvement during their acute childhood illness. An age and sex-matched group (n=14) with normal CMRs was selected for comparison. Rest MBF was corrected for heart rate by dividing by the scan heart rate and multiplying by the mean resting heart rate among all subjects. A per-vessel analysis was performed using a linear mixed effects model with pairwise comparisons to assess the effect of coronary abnormalities (normal, aneurysmal with or without thrombosis, revascularised) on myocardial perfusion reserve (MPR). Results 28 patients were included (14 Kawasaki; 14 controls). All patients in the Kawasaki cohort had assessment of coronary anatomy either by CT (93%) or invasive (7%) coronary angiography. A total of 84 vessels were analysed. Mean age and sex were well matched (Kawasaki: 27±6.2 years; 13 males : 1 female vs. controls: 27±6.4 years; 13 males : 1 female). In patients with Kawasaki disease, thrombosed aneurysmal arteries were associated with a significantly impaired MPR compared to normal (mean Δ: -0.817; P=0.003) and aneurysmal (mean Δ: -0.957; P&amp;lt;0.001) arteries. MPR in aneurysmal and revascularised arteries were not significantly different from normal arteries in patients with Kawasaki disease. There was no significant difference in MPR between normal coronary arteries in patients with Kawasaki compared to controls. Conclusions Thrombosis in coronary aneurysms was associated with a significant impairment of myocardial perfusion in adult patients with convalescent Kawasaki disease. There was no significant reduction in perfusion in territories supplied by normal or aneurysmal arteries which does not support coronary microvascular dysfunction in these patients. Further studies are needed to confirm these preliminary findings.

Introduction Osler‐Weber‐Rendu disease, also known as hereditary hemorrhagic telangiectasia (HTT), is a developmental vascular disease characterized by multiple arteriovenous malformations (AVMs) due to genetic defects in endothelial angiogenesis pathways. HHT is a clinical diagnosis based on the fulfillment of the Curacao Diagnostic Criteria, including involvement of internal organs with AVMs, significant recurrent nosebleeds, telangiectasias, and family history of HHT. HHT has a prevalence of 1.5 to 2 people/10,000, although this is considered a falsely low representation due to missed diagnosis and variable penetrance. Autosomal dominantly inherited heterozygous mutations disrupt the TGF‐beta‐mediated pathways causing aberrant blood vessel development with fragility and AVM formation. There are two forms of HHT: (HHT1) has a higher incidence in women and typically involves pulmonary and cerebral arteriovenous malformations (AVM). Mutations in the endoglin gene are thought to be responsible for HTT1 and comprise approximately 61% of the cases. HTT2 is associated with a higher rate of liver AVMs, involves a mutation in Activin A Receptor‐Like Type 1 (ACVRL1), and is responsible for approximately 37% of cases. Other genetic mutations include SMAD4 and GDF2, which are transmitter and binding proteins and occur about 2% of the time. Methods Case report and review of literature Results Case:A 52‐year‐old woman with a large frontoparietal arteriovenous malformation originally found at the age of 17, with a history of frequent epistaxis, mucocutaneous telangiectasias and two children with epistaxis and telangiectasias. Her diagnosis of HHT was made at her third hjospitalization due to a non‐traumatic subarachnoid hemorrhage. A Chest CT angiography and a CT angiography of the intra and extracranial vasculature demonstrated an extensive right holohemispheric cerebral AVM, an unruptured 8‐mm basilar artery aneurysm, and multiple enlarged pulmonary arteries with narrow inlet and outlets concerning for pulmonary AVMs. A subsequent digital subtraction angiogram (DSA) of the brain confirmed the extensive holohemispheric AVM, unruptured basilar artery aneurism with subarachnoid hemorrhage originating from the AVM. On examination she had multiple lingual, and hard/soft palate telangiectasias and an extensive anterior pedal telangiectasia. Given the heavy cerebral AVM burden with multiple cerebral artery feeders, the AVM angiosclerosis and basilar artery aneurysm embolization were deferred. The patient proceeded under medical management alone with a plan for personal and familial genetic testing. Conclusion HHT is a rare cause of cerebral AVMs at high risk of spontaneous bleeding. Managing these AVMs can be a challenge, given the extent and location of these. However, diagnosis of HHT can inform prognosis and guide medical management due to improved prognosis for HHT‐related AVMs and aneurysms compared to non‐HHT AVMs.