Endovascular Embolization of a Ruptured Distal Lenticulostriate Artery Aneurysm in Patients with Moyamoya Disease

diagnostic angiography was performed to detect any bleeders, and revealed a ruptured aneurysm in the left medial LSA, supplying the frontal cortex via medullary vessels (Fig. 1A).The aneurysm was located in a branch of this LSA, which was another medullary vessel connected with the insular branch of the M2 segment (Fig. 1B).Because the patient was uncooperative, the procedure was performed under general anesthesia.Echelon-14 microcatheter (EV3, Irvine, CA, USA) was positioned directly at the target branch with the aneurysm using Synchro-14 wire (Stryker, Fremont, CA, USA) in order to save medullary vessels from this LSA.Selective angiogram showed that delayed filling defect in the M2 branch, which was connected with the LSA.This finding confirmed another collaterals to this lesion (Fig. 1B).The target branch was perfectly wedged by the microcatheter.To prevent a retrograde filling of the aneurysm from the M2 branch, the target branch of the LSA was embolized with a 33% NBCA mixture with lipiodol up to the point connecting with the insular branch of the M2 (Fig. 1C).Postembolization angiogram showed no aneurysmal filling.Patent distal vessels of the LSA and M2 branches were also confirmed (Fig. 1D).Follow-up CT scan showed the aneurysm and target branch filled with NBCA (Fig. 1E).No infarction in the adjacent structure and cortex area was detected on diffusion weighted imaging