J Cerebrovasc Endovasc Neurosurg.  2024 Jun;26(2):181-186. 10.7461/jcen.2023.E2023.08.003.

Coil embolization and recurrence of ruptured aneurysm originating from hyperplastic anterior choroidal artery

• Youn S
• Park SK
• Kim MJ

• KMID: 2556980
• DOI: http://doi.org/10.7461/jcen.2023.E2023.08.003

Abstract

Hyperplastic anterior choroidal artery (AchA) is an extremely rare congenital vascular variant that can be mistaken for other cerebral arteries. This case report presents a 38-year-old man who presented with a severe sudden-onset headache and was diagnosed with a ruptured aneurysm originating from a hyperplastic AchA. The aneurysm was successfully treated with coil embolization, but recurrence was detected after eight months, leading to additional surgical intervention. The discussion highlights the classification of hyperplastic AchA and emphasizes the importance of recognizing this anatomical variant to avoid complications during treatment. This case report underscores the need for awareness and understanding of hyperplastic AchA in the management of cerebral aneurysms.

Keyword

Intracranial aneurysm; Ruptured aneurysm; Recurrence; Hyperplastic anterior choroidal artery; Endovascular aneurysm repair; Microsurgery

Figure

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  Fig. 1. (A) Brain computed tomography (CT) reveals subarachnoid hemorrhage (SAH) within the bilateral sylvian fissure, perimesencephalic region, and basal cisterns. (B) CT angiography shows an aneurysm protruding superiorly from the left distal internal carotid artery (ICA) (open arrow).

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  Fig. 2. (A) Vertebral angiography with the Alcock test demonstrates a normal posterior communicating artery (Pcom) (black arrow). The aneurysm (open arrow) originates from the anomalous hyperplastic anterior choroidal artery (H-AchA) (white arrow), and some anomalous temporal branches are observed distally (open arrowhead). The posterior cerebral artery (PCA) follows its typical course, and the distal uncal branch is observed normally (white arrowhead). (B) The 3D rotation view shows the aneurysm (open arrow) originating from the H-AchA (white arrow), along with the distal normal uncal branch of the PCA (white arrowhead). Additionally, some anomalous temporal branches from the H-AchA are observed distally (open arrowhead).

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  Fig. 3. (A) The aneurysm was treated with simple coil embolization (white arrow). (B) After 8 months, magnetic resonance angiography (MRA) reveals the recurrence of the coiled aneurysm (open arrowhead). (C) Transfemoral cerebral angiography (TFCA) confirmed the recurrence of the aneurysm with coil compaction (black arrow). (D) Recurred aneurysm (black arrowhead) is seen between ICA (open arrow) and H-AchA (white arrow). Finally, surgical clipping was performed at the recurrent aneurysm. ICA, internal carotid artery; H-AchA, hyperplastic anterior choroidal artery

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