Endovascular treatment of anastomotic duplicated middle cerebral artery aneurysm: Report of two cases

Abstract

Background: Anastomotic duplicated middle cerebral artery (MCA) is rare arterial variant. We present two cases of intracranial aneurysm arising from an anastomotic duplicated MCA that were treated by coil embolization and discuss the treatment strategy according to the location of the aneurysm relative to the anastomosis. Case description:: Case 1: A 68-year-old man was found to have an unruptured aneurysm arising from the proximal end of an anastomotic duplicated MCA. The treatment options were evaluated by indirect balloon test occlusion of the M1 segment, which demonstrated the robustness of the anastomosis between the duplicated MCA and M1 and the absence of other arteries arising from the duplicated MCA. Based on the angiographic findings, the aneurysm was treated by simple coil embolization with the possibility of sacrificing the smaller branch of the duplicated MCA, and achieved complete obliteration of the aneurysm.Case 2: A 72-year-old woman presented with sudden onset of headache and was diagnosed with subarachnoid hemorrhage caused by an aneurysm at the distal end of an anastomotic duplicated MCA. As the aneurysm projected at the extended line of a temporal branch of the duplicated MCA, the patient underwent endovascular coiling via the temporal branch, resulting in complete obliteration without any difficulties. Conclusions: Two cases of anastomotic duplicated MCA aneurysm are reported. Because the treatment strategy varies according to the site of the aneurysm with respect to the anastomosis, preoperative evaluation of the vascular structure is crucial in selecting the treatment strategy.