A Ruptured lenticulostriate artery aneurysm in moyamoya disease treated with Onyx embolization

Abstract

Lenticulostriate artery (LSA) aneurysms are uncommon. Here, we report one case of ruptured LSA aneurysm which is related to Moyamoya disease (MMD). Surgical treatment of this aneurysm is challenging because of its deep location and complex neural structures around the LSA. We report one case treated with endovascular Onyx embolization, successfully and review LSA aneurysm associated with MMD.

Ruptured saccular aneurysm of the lenticulostriate artery embolized without parent artery occlusion in a case of moyamoya disease

“…The advantage of Onyx and NBCA to fill a ruptured LSA aneurysm has been reported when the parent LSA caliber is small. 17 However, as seen in our case, when the parent LSA is developed well enough that a microcatheter can be advanced, the microcatheter can also be safely advanced into a ruptured LSA aneurysm. In addition, a developed LSA can perfuse a wider cerebral region, compared to an undeveloped LSA.…”

“…Though we did not rule out the possibility of a pseudoaneurysm based on the pathological findings, we thought that the ruptured aneurysm might have resulted from hemodynamic stress. An LSA aneurysm with moyamoya disease is often located near the basal ganglia area, 17 thus, direct surgery to clip or dissect the ruptured LSA aneurysm can be invasive. The advantage of Onyx and NBCA to fill a ruptured LSA aneurysm has been reported when the parent LSA caliber is small.…”

Parent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals

“…In the development of MMD, brain blood flow is redistributed, and alterations in cerebral blood flow may result in the formation of moyamoya vessels and the dilation of non-occluded vessels as collateral passages (2,5,7,(17)(18)(19)(20). Moyamoya vessels mainly refer to the proliferative LSA in the basal ganglia (13,15). The collateral passage is defined as a blood vessel capable of compensating for the progressive occlusion of anterior circulation, including the posterior communicating artery and PCA, the AchA, the thalamoperforating artery, the posterior choroidal artery, and the ophthalmic artery (21).…”

“…Due to brain hemodynamic alterations and the fragile nature of moyamoya vessels and collaterals, aneurysms can develop in or on them ( 6 , 13 , 15 , 20 ). In Larson et al's ( 22 ) systematic review about the location of the associated aneurysm in MMD, 33.7% of aneurysms were located at the non-major artery type, belonging to the type on moyamoya vessels or on collaterals.…”

“…If the parent artery was not tortuous or thick enough and if the aneurysm was not far from the major trunk artery, an Echelon-10 microcatheter (Medtronic, Irvine, California, USA) under 0.014-inch microguidewire navigation was used to perform PAO with coiling. If the Echelon-10 microcatheter was too thick to pass through the parent artery or if the aneurysm was too far from the major trunk artery and periphery, a soft Marathon microcatheter (Medtronic, Irvine, California, USA) with a 1.5F tip under 0.012- or 0.010-inch microguidewire navigation was used to perform PAO with casing Onyx (Medtronic, Irvine, California, USA) ( 14 , 15 ).…”