Coil embolization for the distal anterior choroidal artery aneurysm with extensive collateral flow in Moyamoya disease: a case report

Abstract

Objective: We report a case of a ruptured distal anterior choroidal artery (AChoA) aneurysm associated with Moyamoya disease that was successfully treated by coil embolization.Case presentation: A 70-year-old female with Moyamoya disease presented with intracerebral hematoma and underwent emergent evacuation of the hematoma. Postoperative angiogram revealed a right distal AChoA aneurysm, which was considered the culprit lesion. Initially, the occlusion of AChoA with n-butyl-2-cyanoacrylate was planned. Selective angiogram of AChoA, however, showed extensive collateral flow to the ipsilateral middle cerebral artery, thus we changed therapeutic strategy to the endovascular occlusion of the aneurysm. The aneurysm was successfully embolized with electrical detachable coils and the patient was discharged eventfully.Conclusion: In treating distal AChoA aneurysms associated with Moyamoya disease, selective angiography was useful to evaluate the extension of collaterals, which strongly influence therapeutic strategy.