NEUROIMAGE Year : 2023  |  Volume : 71  |  Issue : 4  |  Page : 845-846

Simple Coiling of Ruptured Duplicated Anterior Choroidal Artery Aneurysm: Not So Simple

Ashok Narayan, Ravinder Sahdev, Bharat Hosur
Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission18-May-2023Date of Decision18-May-2023Date of Acceptance18-May-2023Date of Web Publication18-Aug-2023

Correspondence Address:
Bharat Hosur
Department of Radiodiagnosis, Armed Forces Medical College, Pune - 411 040, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0028-3886.383816

How to cite this article:
Narayan A, Sahdev R, Hosur B. Simple Coiling of Ruptured Duplicated Anterior Choroidal Artery Aneurysm: Not So Simple. Neurol India 2023;71:845-6

A 56 year-old-female presented after 5 days of acute onset thunderclap headache associated with vomiting and transient loss of consciousness. On initial evaluation, she had right hemiparesis and partial right visual field defect in the form of nasal hemianopia. Her non-contrast CT head revealed a Fisher-IV subarachnoid hemorrhage epicentered around suprasellar and right Sylvian fissures. CT angiography showed a lobulated aneurysm arising from the communicating segment of the left internal carotid artery (ICA). Digital subtraction angiography (DSA) with 3D rotational angiography (3-DRA) showed duplicated anterior choroidal artery (AChoA), both arising from the aneurysmal neck [Figure 1]. Unassisted endovascular coiling of the aneurysm was done with the patent flow in both the AChoA on check angiograms. The patient completely recovered from the vasospasm and returned home without any motor deficits.

Figure 1: DSA (a and c) with 3DRA (b and d) of left internal carotid artery showing lobulated aneurysm (straight arrow in a) in the communicating segment. Both the duplicated anterior choroidal arteries arise from the aneurysmal neck (curved arrows in b and d), while the posterior communicating artery origin is seen separately, proximal to the aneurysm (arrowhead in b and d). Check angiogram showed complete aneurysmal occlusion by coil mass (straight arrow in c) with preserved arteries and choroidal blush

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AChoA is a critical branch of ICA, distal to the posterior communicating artery, with a typical plexal point in its course on angiography.[1] Occlusion of AChoA classically results in hemiplegia, hemianesthesia, and contralateral hemianopia. Double origin of AChoA is described to vary from 4% to 13% based on ethnicity and has a higher incidence of associated aneurysm.[2] Our case corresponds to the ostial aneurysm of type IIa as per the recent classification.[3] Distal AChoA aneurysms can be safely treated by sacrificing the vessel distal to the plexal point, unlike those at ostia.[4] Hence, proper angiographic evaluation before and after coiling/clipping is mandatory to ensure optimal aneurysmal occlusion and patency of the duplicated AChoA.

Abbreviations

Digital subtraction angiography – DSA

3D rotational angiography – 3DRA

Declaration of patient consent

The patient has provided informed consent for publication of the case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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    3.Duan Y, Qin X, An Q, Liu Y, Li J, Chen G. A new classification of anterior choroidal artery aneurysms and its clinical application. Front Aging Neurosci 2021;13:596829. doi: 10.3389/fnagi.2021.596829.  
    4.Inci S, Arat A, Ozgen T. Distal anterior choroidal artery aneurysms. Surg Neurol 2007;67:46-52; discussion 52.  
    
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