Medicina (Sep 2024)

Endovascular Therapy of Ruptured Aneurysms on Moyamoya Collateral Vessels: Two Cases

  • Pavel Ryška,
  • Miroslav Lojík,
  • Jiřina Habalová,
  • Carmen Kajzrová,
  • Tomáš Česák,
  • Eva Vítková,
  • Michael Bartoš,
  • Zdeněk Bělobrádek,
  • Antonín Krajina

DOI
https://doi.org/10.3390/medicina60091499
Journal volume & issue
Vol. 60, no. 9
p. 1499

Abstract

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Background: Using two case reports of adult women with moyamoya disease presenting with intracranial hemorrhage from ruptured aneurysms on moyamoya collateral vessels, we aim to demonstrate the potential for effective endovascular treatment navigated by CT angiography, digital subtraction angiography, and flat panel CT. Case 1 Presentation: A 45-year-old female patient with sudden onset of headache, followed by somnolency. CT scan showed a four-ventricle hematocephalus caused by a 27 × 31 × 17 mm hematoma located in the left basal ganglia. Angiography revealed a 3 mm aneurysm on hypertrophic lenticulostriate artery bridging the M1 occlusion. Selective catheterization and distal embolisation with acrylic glue was done. Case 2 Presentation: A 47-year-old woman was admitted for a sudden onset of severe headache, CT scan showed four-ventricle hematocephalus. A 4 mm aneurysm on the collateral vessel–anterior chorioidal artery bridging the closure of the terminal segment of the internal carotid artery was diagnosed as the source of bleeding. Selective catheterization and distal embolisation with acrylic glue was done. Conclusions: Selective embolisation of ruptured aneurysms on moya moya collaterals is a simple, effective, and safe procedure when relevant microcatheters are used with imaging software navigation such as 3D DSA, 3D road map and flat-panel CT.

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