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Case Reports
. 2014 Dec;20(6):791-5.
doi: 10.15274/INR-2014-10071. Epub 2014 Dec 5.

Endovascular treatment of a ruptured flow aneurysm of the heubner artery as part of a moyamoya collateral network in a young patient with an occluded middle cerebral artery

Ratna S Bechan  1 , Willem Jan van Rooij  2
Affiliations
Case Reports

Endovascular treatment of a ruptured flow aneurysm of the heubner artery as part of a moyamoya collateral network in a young patient with an occluded middle cerebral artery

Ratna S Bechan et al. Interv Neuroradiol. 2014 Dec.

Abstract

A young woman with an occluded middle cerebral artery presented with a ruptured flow aneurysm distal on a Heubner artery as part of a moyamoya collateral network. Leptomeningeal collateral supply was tested by occlusion of the A1 origin of the Heubner artery. This test occlusion demonstrated ample collateral leptomeningeal supply over the hemispheres to the M2. Subsequently, the Heubner artery harbouring the aneurysm could be safely proximally occluded with coils.

Keywords: Heubner artery; leptomeningeal collateral circulation; moyamoya; test occlusion.

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Figures

Figure 1
Figure 1
CT scan with subarachnoid, intraventricular and intraparenchymal blood.
Figure 2
Figure 2
Frontal right internal carotid angiogram in early (A), mid (B) and late (C) phase showing M1 occlusion and perfusion of right hemisphere by the basal collateral moyamoya network and leptomeningeal collateral vessels.
Figure 3
Figure 3
3D angiogram of the right internal carotid artery shows the occluded middle cerebral artery at its origin (long arrow), hypertrophied Heubner artery as part of a collateral network (small arrows) and ruptured aneurysm on the distal Heubner artery (broad arrow).
Figure 4
Figure 4
Test occlusion of the right A1. A) Balloon inflated in the right A1 occluding the origin of the Heubner artery. B-F) Arterial, parenchymal and venous phases of left internal carotid angiogram during test occlusion: abundant leptomeningeal collateral supply over the hemispheres with synchronous venous phase filling.
Figure 5
Figure 5
Bilateral internal carotid angiogram after proximal coil occlusion of the Heubner artery (arrows).
See this image and copyright information in PMC

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