Selective Coil Embolization of Ruptured Fusiform Aneurysm Involving Anterior Choroidal Artery and Posterior Communicating Artery

Abstract

Background: We report a case of a ruptured fusiform aneurysm of the distal internal carotid artery (ICA) involving the anterior choroidal artery and posterior communicating artery, treated with selective coil embolization.

Case description: An 86-year-old woman was admitted with subarachnoid hemorrhage. Computed tomography and computed tomography angiography showed diffuse subarachnoid hemorrhage with a fusiform aneurysm, as well as severe atherosclerotic change in the distal ICA. A transfemoral cerebral angiogram showed a fusiform aneurysm in the supraclinoid segment of the ICA with a daughter sac. The bleb lesion was considered the cause of the bleed. The suspected bleeding point was selectively obliterated using the double-microcatheter technique. The patient was discharged without focal neurologic deficits. The treatment of choice for a ruptured fusiform aneurysm remains controversial.

Conclusions: Mostly, surgical clipping (vascular reconstruction, proximal occlusion, or trapping) with bypass surgery is necessary for this lesion. However, in our case, selective coiling was successfully performed only at the suspected rupture point. This technique can be a good alternative treatment modality.

Keywords: Aneurysm; Endovascular procedure; Fusiform; Subarachnoid hemorrhage.