Background
We describe a rare case with partially thrombosed fusiform anterior choroidal artery
(AchA) aneurysm successfully treated with therapeutic occlusion of the AchA.
Clinical presentation
A 58-year-old man presented with transient mild hemiparesis of the right side. Magnetic
resonance imaging (MRI) showed an ischemic lesion in the posterior limb of the left
internal capsule. Digital subtraction angiography (DSA) revealed a left internal carotid
artery saccular aneurysm (14.5-mm diameter) arising from the supraclinoid segment.
The left AchA was not detected in the initial DSA, and MRI showed the aneurysm to
be partially thrombosed. The second DSA performed 2 weeks after the onset showed recanalization
of the thrombosed portion of the aneurysm with the left AchA apparently arising from
its tip. The aneurysm was diagnosed as a partially thrombosed fusiform AchA aneurysm.
Results
Open surgery was performed and a titanium clip was applied to the base of the fusiform
aneurysm under motor evoked potential monitoring, which remained unchanged after clipping.
Occlusion of the aneurysm was confirmed by Doppler ultrasound and intraoperative fluorescence
angiography. Furthermore, Doppler ultrasound and fluorescence angiography showed that
the blood flow supplying the pyramidal tract was reconstituted by the retrograde collateral
flow from the choroidal segment. The aneurysm was completely obliterated in postoperative
DSA, which demonstrated retrograde filling of the AchA through the posterior circulation.
The patient manifested transient weakness of the right side postoperatively, which
was completely recovered after short-term rehabilitation.
Conclusions
This case illustrates the unique clinical course of a rare partially thrombosed fusiform
AchA aneurysm, successfully treated with therapeutic clip occlusion of the AchA under
the multimodal monitoring.
Key Words
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Article info
Publication history
Published online: May 13, 2015
Accepted:
April 17,
2015
Received in revised form:
April 11,
2015
Received:
January 29,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.024
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
