Thromboembolic Complication following Neurointervention in Ruptured Anomalous Hyperplastic Anterior Choroidal Artery Aneurysm

Abstract

SUMMARY -

Anomalous Origin of the Anterior Choroidal Artery Proximal to an Ipsilateral Fetal Posterior Cerebral Artery: Case Report of an Extremely Rare Anatomic Variant and Discussion of its Clinical Implications

“…The same anatomic series also described a handful of MCA and PCoA origins of the AChA and in one case a common origin of the PCoA and AChA [3,9]. Knowledge regarding anomalous manifestations of the AChA is extremely important in open surgical and endovascular procedures to prevent devastating neurological consequences [2,13]. The AChA has an extensive branching pattern that supplies a number of critical structures, including the globus pallidus interna, posterior limb of the internal capsule, optic tract, parts of the thalamus, tail of the caudate nucleus, cerebral peduncle, substantia nigra, red nucleus, and choroid plexus [1,2].…”

“…Knowledge regarding anomalous manifestations of the AChA is extremely important in open surgical and endovascular procedures to prevent devastating neurological consequences [2,13]. The AChA has an extensive branching pattern that supplies a number of critical structures, including the globus pallidus interna, posterior limb of the internal capsule, optic tract, parts of the thalamus, tail of the caudate nucleus, cerebral peduncle, substantia nigra, red nucleus, and choroid plexus [1,2]. Hyun et al described a case of coil embolization of an aneurysm associated with an anomalous AChA that led to acute infarction of the internal capsule despite continued patency of the AChA post-surgically [2].…”

“…The AChA has an extensive branching pattern that supplies a number of critical structures, including the globus pallidus interna, posterior limb of the internal capsule, optic tract, parts of the thalamus, tail of the caudate nucleus, cerebral peduncle, substantia nigra, red nucleus, and choroid plexus [1,2]. Hyun et al described a case of coil embolization of an aneurysm associated with an anomalous AChA that led to acute infarction of the internal capsule despite continued patency of the AChA post-surgically [2]. Various studies described the most common neurologic deficits associated with AChA infarction.…”

“…The anterior choroidal artery (AChA) serves a critical role during brain development and continues to supply a number of eloquent structures in the adult brain, including the globus pallidus interna, posterior limb of internal capsule, optic tract, parts of the thalamus, tail of the caudate nucleus, cerebral peduncle, substantia nigra, red nucleus, and choroid plexus [1][2][3]. It is classically described as the terminal branch of the communicating segment of the internal carotid artery (ICA), arising laterally and distally to the posterior communicating artery (PCoA) [2,[4][5][6]. Numerous reports have described variations to the branching pattern, course, size and ultimate vascular territory of the AChA [6][7][8], but variation in the origin of the vessel distal to the posterior communicating artery is rarely observed.…”

An anomalous hyperplastic anterior choroidal artery associated with an unruptured internal carotid–posterior communicating artery aneurysm

“…reported that 24% of anomalous hyperplastic AChAs were accompanied by choroidal artery aneurysms, with 8% of aneurysms occurring at its bifurcation. As the AChA is an end artery usually without any anastomosis or perfusion from other arteries, injuries to the AChA can cause severe neurologic deficit [1] . Furthermore, an anomalous hyperplastic AchA has a lengthy course with numerous choroidal and perforating branches and, therefore, an extensive perfusion region.…”