Distal Anterior Choroidal Artery Research Articles

Use of a flow diverter in a small-caliber end artery anterior choroidal dissecting pseudoaneurysm: illustrative case.

Anterior choroidal artery (AChA) fusiform aneurysms are exceedingly rare and associated with high rebleeding and mortality rates. Their difficult anatomy comes with a broad range of treatment options, including bypass, stent-assisted coiling, and flow diversion. Currently, flow diverters are approved for large-caliber internal carotid artery segment aneurysms. However, many institutions have expanded their use to distal small-caliber vessels, which raises questions regarding device sizing and long-term patency. The authors present a dissecting distal AChA fusiform pseudoaneurysm treated successfully with flow diversion. A 40-year-old woman with monoclonal gammopathy of unknown significance, lichen sclerosis, and an unspecified connective tissue disease presented with diffuse subarachnoid hemorrhage. She had a dissecting, 5 × 3-mm, left AChA pseudoaneurysm 4 mm distal to the origin of the vessel. A 2.5-mm flow redirection endoluminal device was deployed. There were no procedural complications. A 6-month cerebral angiogram showed device patency and no pseudoaneurysm remnant. These results were maintained at 1 year as seen on head magnetic resonance angiography. Flow diversion is a successful and safe therapeutic intervention for challenging intracranial aneurysms originating from small-caliber vessels supplying eloquent vascular territories.

Abstract Number ‐ 85: Distal Anterior Choroidal Artery Fusiform Aneurysm Successfully Treated with Flow Diversion

Introduction Anterior choroidal artery (AChA) aneurysms account for 3–5% of intracranial aneurysms, and are often saccular, arising at or near the origin of the AChA, with distal lesions being exceedingly rare. Contrary to saccular aneurysms, fusiform aneurysms are associated with a higher risk of rebleeding and mortality due to their formidable anatomy requiring advanced techniques including bypass, stent‐assisted coiling, and, more recently, flow diversion. While flow diverters are becoming more popular, they are currently only approved forinternal carotid artery segment aneurysms. However, many institutions areexpanding their use to more distal and smaller caliber vessels. Herein we present a novel pathology of a dissecting distal AChA fusiform pseudoaneurysm with a small vessel caliber treated successfully with flow diversion. Methods Case presentation and surgical technique. Results We describe a 40‐year‐old woman with monoclonal gammopathy of unknown significance (MGUS), lichen sclerosis, and an unspecified connective tissue disease presenting with diffuse subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies 1; Hunt & Hess scale 2; Modified Fisher Scale 3). A digital subtraction cerebral angiogram revealed a dissecting (5×3 mm) left AChA pseudoaneurysm, 4mm distal to the origin (Figure 1). Flow Redirection Endoluminal Device (FRED Jr, Microvention, CA) (2.5mm 8/13 working/total length) was deployed within the vessel proximal to the aneurysm, preceded by an infusion of 5mg of verapamil to facilitate stent placement (Figure 2). Post procedure, she remained neurologically intact and was discharged on dual antiplatelet therapy (aspirin/ticagrelor). Repeat cerebral angiogram at six months showed patent flow diversion device and no pseudoaneurysm remnant (Figure 3) with a nonfocal physical examination. Conclusions Flow diversion may be a successful, and safe, therapeutic intervention for challenging distal intracranial aneurysms with smaller caliber vessels.

Parent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals.

Aneurysms in moyamoya vessels or on collaterals are difficult to treat. Parent artery occlusion (PAO) via endovascular treatment (EVT) is often the last resort, but the safety and efficacy of this approach need to be evaluated. A retrospective study was performed on patients admitted to our hospital who were diagnosed with unilateral or bilateral moyamoya disease (MMD) associated with ruptured aneurysms in moyamoya vessels or on collaterals. These aneurysms were treated with PAO, and the clinical outcome was recorded. Eleven patients were aged 54.7 ± 10.4 years, and six patients were male (54.5%, 6/11). The aneurysms in 11 patients were single and ruptured, and the average size was 2.7 ± 0.6 mm. Three (27.3%, 3/11) aneurysms were located at the distal anterior choroidal artery, 3 (27.3%, 3/11) were at the distal lenticulostriate artery, 3 (27.3%, 3/11) were at the P2-3 segment of the posterior cerebral artery, 1 (9.1%, 1/11) was at the P4-5 segment of the posterior cerebral artery, and 1 was at the transdural location of the middle meningeal artery. Among the 11 aneurysms, PAO by coiling was performed on 7 (63.6%, 7/11), and Onyx casting was performed on 4 (36.4%, 4/11). Of 11 patients, 2 (18.2%, 2/11) suffered intraoperative hemorrhagic complications. During follow-up, all patients had good outcomes with a modified Rankin scale score of 0-2. As a last resort, the application of PAO with coiling or casting Onyx for ruptured aneurysms in moyamoya vessels or on collaterals may be safe with an acceptable clinical outcome. However, patients with MMD may not always achieve expected health outcomes, and PAO for the aneurysm can bring only temporary relief.

Distal Anterior Choroidal Artery Dissecting Aneurysm Presenting as Ischemic Stroke- Imaging and Management.

Distal Anterior Choroidal Artery Dissecting Aneurysm Presenting as Ischemic Stroke- Imaging and Management.

Using a New Landmark of the Most External Point in the Embolization of Distal Anterior Choroidal Aneurysms: A Report of Two Cases.

There are landmarks on the course of the anterior choroidal artery (AChoA), such as the original point (OP) and the plexal point (PP), as documented in previous articles. In these previous articles, the AChoA was the terminal branch of the internal carotid artery (ICA), which had two segments throughout its course. The first cisternal segment began from the origin and ended at the point where the artery reached the choroidal fissure (the PP). The second segment consisted of one or more branches, which passed through the choroidal fissure and entered the choroid plexus. However, we found another angiographic landmark, named the most external point (MEP), along the course of the AChoA in the anteroposterior (AP) view. There was a sharp turn at the outermost limit of the course of the AChoA, and then the AChoA progressed inward and upward. We defined the outermost limit as the MEP of the AChoA. This study describes two rare cases of distal AChoA aneurysms associated with arteriovenous malformation (AVM) and Moyamoya disease that developed intraventricular hemorrhage, and we used the parent artery occlusion (PAO) technique to embolize the distal AChoA lesions at the MEP. The patients recovered well without any neurological complications.

Intraventricular Hemorrhage due to a Distal Anterior Choroidal Artery Aneurysm Associated with an Arteriovenous Malformation in the Trigone

Intraventricular Hemorrhage due to a Distal Anterior Choroidal Artery Aneurysm Associated with an Arteriovenous Malformation in the Trigone

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

Distal anterior choroidal artery (AChA) aneurysms are infrequent. We discuss the case of a 59-year-old patient who presented with an isolated intraventricular hemorrhage (IVH) secondary to a ruptured distal AChA aneurysm. Initial noninvasive cerebral computed tomography angiography revealed no evidence of an underlying vascular pathology. The patient underwent further digital subtraction cerebral angiography, which revealed an aneurysm arising from the distal AChA segment. The aneurysm was successfully treated with surgical clip ligation. The current study highlights the importance of considering a ruptured distal AChA aneurysm as a potential source of isolated IVH.

Moyamoya disease complicated by a bleeding distal anterior choroidal artery aneurysm: Approach, management and review of literature

Moyamoya disease complicated by a bleeding distal anterior choroidal artery aneurysm: Approach, management and review of literature

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

We report a case of a ruptured distal anterior choroidal artery (AChoA) aneurysm associated with moyamoya pattern collateralization secondary to the middle cerebral artery occlusion. Patient was successfully treated with the coil embolization of the distal AChoA. This case supports the feasibility and efficacy of the endovascular therapy for the distal AChoA aneurysms in patients with MCA occlusion with moyamoya pattern collateralization.

Rare Distal Anterior Choroidal Artery Aneurysm

Objective: To describe a rare patient with ruptur aneurysm case of distal anterior choroidal artery (AChA) and intraventricular hemorrhage. A 56-year old female came to our hospital with chief complaint sudden onset of severe headache and vomiting. Methods: Head computed tomography (CT)-scan and angiography on the lesion was performed at the Department of Radiology, Siloam Hospital, Tangerang, Indonesia. Results: Head CT-scan imaging revealed an intraventricular hemorrhage, primarily in the right lateral ventricle, with slight enlargement of both lateral, 3rd and 4th ventricles. Angiography examination revealed a round vascular lesion at the wall of the posterior cornu of the lateral ventricle and an occlusion of the M1 base segment of the left middle cerebral artery. Conclusions: The lesion, distal AChA aneurysm, at the posterior cornu was reached using an infratemporal lobe approach with the help of neuronavigation. Microsurgical clipping was successfully performed. Keywords: Aneurysm, distal anterior choroidal artery, neuronavigation DOI: 10.15850/ijihs.v4n2.837

Anterior Choroidal Artery Aneurysm Associated With Moyamoya Disease

The clinical course and management of anterior choroidal artery (AChoA) aneurysms associated with moyamoya disease (MMD) have not been fully clarified. A 61-year-old man experienced dysarthria. CT revealed hemorrhage in the lateral ventricles, and an aneurysm in the left lateral ventricle. MRI performed 13 months prior to the onset showed no aneurysm. Angiography on admission demonstrated an aneurysm of about 4 mm in diameter on the left anterior choroidal artery. Repeated angiography on the ninth day showed enlargement of the aneurysm. However, MRI and angiography demonstrated the disappearance of the aneurysm on the 17th day. On the 38th day, superficial temporal artery-middle cerebral artery bypass was performed to decrease the hemodynamic stress on the distal arteries. Follow-up angiography showed no recurrence of the aneurysm. This is the first reported case of a distal anterior choroidal artery aneurysm, which was previously undetectable, showing enlargement followed by spontaneous disappearance. Distal aneurysms associated with MMD occasionally regress. Therefore, close radiological observation is necessary. J Neurol Res. 2016;6(1):24-27 doi: http://dx.doi.org/10.14740/jnr371w

Anterior Choroidal Artery Aneurysm Associated With Moyamoya Disease

The clinical course and management of anterior choroidal artery (AChoA) aneurysms associated with moyamoya disease (MMD) have not been fully clarified. A 61-year-old man experienced dysarthria. CT revealed hemorrhage in the lateral ventricles, and an aneurysm in the left lateral ventricle. MRI performed 13 months prior to the onset showed no aneurysm. Angiography on admission demonstrated an aneurysm of about 4 mm in diameter on the left anterior choroidal artery. Repeated angiography on the ninth day showed enlargement of the aneurysm. However, MRI and angiography demonstrated the disappearance of the aneurysm on the 17th day. On the 38th day, superficial temporal artery-middle cerebral artery bypass was performed to decrease the hemodynamic stress on the distal arteries. Follow-up angiography showed no recurrence of the aneurysm. This is the first reported case of a distal anterior choroidal artery aneurysm, which was previously undetectable, showing enlargement followed by spontaneous disappearance. Distal aneurysms associated with MMD occasionally regress. Therefore, close radiological observation is necessary. J Neurol Res. 2016;6(1):24-27 doi: http://dx.doi.org/10.14740/jnr371w

広範な側副血行を有する前脈絡叢動脈末梢部動脈瘤に対してコイル塞栓術を施行したもやもや病の1 例

広範な側副血行を有する前脈絡叢動脈末梢部動脈瘤に対してコイル塞栓術を施行したもやもや病の1 例

広範な側副血行を有する前脈絡叢動脈末梢部動脈瘤に対してコイル塞栓術を施行したもやもや病の1 例

広範な側副血行を有する前脈絡叢動脈末梢部動脈瘤に対してコイル塞栓術を施行したもやもや病の1 例

A case of newly diagnosed moyamoya disease in a pregnant patient with a ruptured aneurysm of the distal anterior choroidal artery embolized using N-butyl cyanoacrylate

Here we describe a rare case of a pregnant patient with a ruptured aneurysm of the distal anterior choroidal artery(AChA)that was embolized using n-butyl cyanoacrylate(NBCA). The 32-year-old patient was 24 weeks pregnant. She suddenly suffered from headache and vomiting. On admission, she was somnolent with left hemiparalysis and had a manual muscle test score of 1/5. Computed tomography(CT)images revealed a cerebral hemorrhage from the right temporal lobe to the lateral ventricle with intraventricular hemorrhage. Cerebral angiography showed severe stenosis at the terminal portion of the right internal carotid artery and a surrounding abnormal vascular network. She was diagnosed with unilateral moyamoya disease, and a direct surgical evacuation of the hemorrhage was performed on the same day. The following day, cerebral angiography showed enlargement of a distal AChA aneurysm that, as suspected, had caused the hemorrhage. The aneurysm was treated by the injection of 20% NBCA into the distal AChA and the aneurysm. After surgery, magnetic resonance imaging showed ischemic changes in the ventral posterolateral nucleus of the thalamus without neurological deficits. The patient became lucid, and the left hemiparalysis improved. The rest of the pregnancy was uneventful. At 37 weeks, she delivered a normal baby by elective caesarean section. When treating pregnant patients with moyamoya disease and a ruptured cerebral artery aneurysm, it is extremely important to cooperate with obstetricians to ensure a safe pregnancy and delivery.

もやもや病に合併し血行再建術後に消失した末梢性破裂前脈絡叢動脈瘤の1例

もやもや病に合併し血行再建術後に消失した末梢性破裂前脈絡叢動脈瘤の1例

Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion

Aneurysms of the anterior choroidal artery are uncommon and account for only 2-5% of all intracranial aneurysms. Distal anterior choroidal artery aneurysms are rare and the pathogenesis of this aneurysm may be different from typical proximal ones. We describe an unusual case of ruptured de novo distal anterior choroidal artery aneurysm in a 55 year-old man who had previously undergone endovascular proximal occlusion for a fusiform aneurysm of the ipsilateral posterior cerebral artery (PCA). A comprehensive review of literature using Medline, PubMed and all related journals was also performed. Only 34 reported distal AchoA aneurysms were found: 16 associated with moyamoya disease, 10 idiopathic, two with atherosclerosis, two with arteriovenous malformation, two dissecting, one infectious and one due to trauma. It is probable that the increased hemodynamic stress within the AchoA contributed to the formation and rupture of the reported aneurysm. This late complication needs to be considered when large intracranial vessels are iatrogenically occluded in the management of complex intracranial aneurysms.

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

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 Embolization of Distal Anterior Choroidal Artery Aneurysms Associated with Moyamoya Disease

We evaluated the feasibility of endovascular embolization for the management of distal anterior choroidal artery (AChA) aneurysms associated with moyamoya disease and performed a literature review to summarize their clinical features and treatment. We describe two cases of moyamoya disease-associated distal AChA aneurysms treated by endovascular embolization. In both cases, a good outcome was observed. We performed a MEDLINE (1980-2010) search which identified 13 similar cases. Our analysis of the clinical data from these 15 cases led us to conclude that (i) endovascular embolization is an effective and feasible treatment for distal AChA aneurysms associated with moyamoya disease; (ii) aneurysm location and the preservation of the parent artery are two major prognostic factors for moyamoya disease-associated distal AChA aneurysms subjected to craniotomy or endovascular therapy; (iii) the parent artery should be preserved when the aneurysm is located in the temporal horn of the lateral ventricle, but sacrificed when it is located in the trigone of the lateral ventricle.

Endoscopic treatment of distal choroidal artery aneurysm

Distal choroidal artery aneurysms stemming from the lateral wall of the ventricles are rare and are mostly associated with moyamoya disease. The treatment of these aneurysms is difficult because of their deep location. The authors report the case of a 50-year-old woman followed for moyamoya disease presenting with 2 intraventricular hemorrhages. Cerebral angiography showed an aneurysm located on the left distal choroidal artery. Magnetic resonance imaging also demonstrated that the lesion protruded from the lateral wall of the trigone of the left lateral ventricle. Using MR imaging-guided stereotactic localization, the aneurysm was accurately reached endoscopically and successfully resected from the parent artery. The patient was discharged neurologically intact. To the best of the authors' knowledge, this is the first report of a successfully endoscopically treated distal anterior choroidal artery aneurysm. Endoscopic surgery may be added to the armamentarium of procedures used to treat intraventricular aneurysms.