A case of ruptured anterior communicating artery aneurysm due to hemodynamic stress of moyamoya disease

Abstract

A 43-year-old man presented with sudden-onset severe headache and was admitted to our hospital. At admission, computed tomography (CT) and CT angiography (CTA) revealed subarachnoid hemorrhage caused by a ruptured anterior communicating artery (A-com) aneurysm. CTA also revealed stenotic changes at the terminal portions of the bilateral internal carotid artery (ICA), occlusion of the bilateral middle cerebral artery (MCA), and accompanying typical moyamoya vessels. We performed coil embolization for the A-com aneurysm and the aneurysm was completely occluded. The postoperative course was uneventful and the patient was discharged home with no significant disability on day 21. Computational fluid dynamics (CFD) analysis using intraoperative 3D angiography data revealed increased hemodynamic stress at the aneurysm site due to the narrowing of MCA. The progression of arterial stenosis in limited lesions, in this case MCA, could cause a dynamic change in cerebral blood flow, which results in aneurysm formation and rupture.