Overcoming the Challenge of Distal Lenticulostriate Artery Aneurysms With Transarterial Embolization: Technical Insights, Case Series, and Literature Review

BACKGROUND AND OBJECTIVES: Distal lenticulostriate artery (LSA) aneurysms are rare but carry a high hemorrhage risk and are often associated with arteriovenous malformations or moyamoya disease. Their deep location and fragile, tortuous vessels pose significant challenges in transarterial embolization (TAE). This study integrates 3 institutional cases with a systematic literature review to identify key endovascular strategies. METHODS: A literature review (1960-2024) identified 16 cases of distal LSA aneurysms treated with TAE, supplemented by our 3 institutional cases. Nineteen aneurysms were assessed for their clinical presentation, procedural details, complications, and outcomes. Seven TAE techniques, vasospasm management, cross-approach through the anterior communicating artery, balloon-assisted microcatheter navigation, use of distal access catheter, pre-embolization testing, targeted embolization, and rescue therapy, were evaluated for their roles in treating distal LSA aneurysms. RESULTS: All 19 aneurysms were completely obliterated, with minor complications in 3 (15.8%) and no severe neurological deficits. No recurrences or rebleeding were observed over a mean follow-up period of 14.1 months. TAE, performed with these 7 techniques, demonstrated both safety and efficacy. CONCLUSION: TAE represents a feasible and promising treatment for managing distal LSA aneurysms, providing favorable occlusion outcomes with relatively low risk of complications. The 7 described techniques serve as practical approaches to address the unique anatomic and hemodynamic challenges associated with distal LSA aneurysm embolization.