2023 Volume 51 Issue 2 Pages 161-166
The anomalous origin and perfusion area of the anterior choroidal artery (AchoA) vary. Herein, we report a rare case of a ruptured cerebral aneurysm related to both the anomalous origin and perfusion area of the AchoA. An 80-year-old woman presenting with deep coma was brought to our hospital by ambulance, and she was diagnosed with subarachnoid hemorrhage. Computed tomography angiography revealed no bleeding source except a 3 mm-dilated proximal segment of the posterior communicating artery (Pcom). Catheter angiography demonstrated that an artery of unknown origin and the Pcom arose from a common trunk of the internal carotid artery, in addition to a small aneurysm projecting from the proximal segment of the Pcom. Imaging analysis using three-dimensional rotational angiography revealed that the artery of unknown origin was an anomalous hyperplastic AchoA with an anterior temporal artery which generally originates from the posterior cerebral artery (PCA). We successfully performed balloon-assisted coil embolization, preserving both the Pcom and AchoA. A ruptured aneurysm related to the anomalous origin and perfusion area of the AchoA has rarely been reported. Treating stroke related to such AchoA anomalies based on the understanding of vascular relations and anatomy of the AchoA and Pcom–PCA distributions is essential in order to avoid surgical complications.
