J Korean Neurosurg Soc.  2014 Dec;56(6):492-495. 10.3340/jkns.2014.56.6.492.

Endovascular Embolization of a Ruptured Distal Lenticulostriate Artery Aneurysm in Patients with Moyamoya Disease

• Hwang K
• Hwang G
• Kwon OK

• KMID: 2191141
• DOI: http://doi.org/10.3340/jkns.2014.56.6.492

Abstract

A ruptured distal lenticulostriate artery (LSA) aneurysm is detected occasionally in moyamoya disease (MMD) patients presented with intracerebral hemorrhage. If the aneurysm is detected in hemorrhage site on angiographic evaluation, its obliteration could be considered, because it rebleeds frequently, and is associated with poorer outcome and mortality in MMD related hemorrhage. In this case report, the authors present two MMD cases with ruptured distal LSA aneurysm treated by endovascular embolization.

Keyword

Moyamoya disease; Cerebral hemorrhage; Therapeutic embolization

MeSH Terms

Aneurysm*
Arteries*
Cerebral Hemorrhage
Embolization, Therapeutic
Hemorrhage
Humans
Mortality
Moyamoya Disease*

Figure

• 

  Fig. 1 A : A ruptured aneurysm (arrow) is located on a branch of the lenticulostriate artery (LSA), which connects this LSA with the insular branch of the M2 segments of left middle cerebral artery (MCA). The LSA is originated from the A1 segment of the anterior cerebral artery (arrowhead), which indicates that the LSA is a medial one. Distal medullary vessels from this LSA are also noted. B : The target branch with the ruptured aneurysm is selected directly with a microcatheter to save the distal medullary vessels. Selective angiogram shows the target branch and the MCA branches connected with it. These MCA branches disappear on selective angiogram after brief contrast opacification (arrow), suggesting other collateral flows. C : N-butyl-cyanoacrylate (NBCA) is injected into the target branch, not over the M2 segment. Arrows indicate the intended target point and the final glue endpoint. D : Postembolization angiogram shows patent flows of the medial LSA, its distal medullary vessels, and the MCA branches. The target branch with the aneurysm is no more seen except its stump (arrowhead). E : The target branch and aneurysm (arrow) filled with NBCA are observed on follow-up CT scan.

• 

  Fig. 2 A : A ruptured aneurysm (arrow) is noted in the distal lenticulostriate artery (LSA). Another aneurysmal dilatation (arrowhead) is also observed on a cortical vessel via distal medullary vessel from this LSA. B : Selective angiogram shows the aneurysm and the cortical branches. Contrast in the cortical branches washes out after brief opacification, suggesting that the LSA with the aneurysm is wedged with a microcatheter and its distal branches are supplied by blood flow via another collaterals (arrows). C : Treatment working view. N-butyl-cyanoacrylate (NBCA) is injected into the LSA up to the aneurysm (arrows). D : Postembolization angiogram shows complete obliteration of the aneurysm and patent flow of the distal cortical branches with the aneurysmal dilatation (arrowhead). E : NBCA filling in the LSA and aneurysm is detected on follow-up CT scan.

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