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Case Reports
. 2020;14(5):183-187.
doi: 10.5797/jnet.cr.2019-0061. Epub 2020 Mar 11.

A Patient with an Unruptured Aneurysm in the Internal Carotid Artery-duplicated Middle Cerebral Artery on Whom Coil Embolization with Balloon Remodeling Was Performed

Ryotaro Suzuki  1 , Tomoji Takigawa  1 , Toru Anazawa  1 , Nobuo Shirasaka  1 , Yoshiyuki Matsumoto  1 , Yoshiko Fujii  1 , Yasuhiko Nariai  1 , Yoshiki Sugiura  1 , Yosuke Kawamura  1 , Issei Takano  1 , Yoshihiro Tanaka  1 , Masaya Nagaishi  1 , Akio Hyodo  1 , Kensuke Suzuki  1
Affiliations
Case Reports

A Patient with an Unruptured Aneurysm in the Internal Carotid Artery-duplicated Middle Cerebral Artery on Whom Coil Embolization with Balloon Remodeling Was Performed

Ryotaro Suzuki et al. J Neuroendovasc Ther. 2020.

Abstract

Objective: Treatment of an unruptured aneurysm at the origin of duplicated middle cerebral artery (DMCA) by coil embolization using balloon remodeling has not been reported. We report a case of coil embolization using balloon remodeling for an unruptured aneurysm at the origin of DMCA.

Case presentation: A 71-year-old female was found to have an unruptured aneurysm at the origin of DMCA during an examination for headache. Coil embolization using balloon remodeling for the wide neck aneurysm to preserve both the internal carotid artery (ICA) and DMCA was successful. The perioperative course was uneventful.

Conclusion: This treatment enables complete embolization, and preserves both the ICA and DMCA. Thus, it is useful for aneurysms at the origin of DMCA.

Keywords: balloon remodeling; cerebral unruptured aneurysm; coil embolization; duplication of middle cerebral artery.

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Conflict of interest statement

We declare no conflict of interest.

Figures

Fig. 1
Fig. 1. Preoperative MRA revealed an aneurysm at the origin of left DMCA. DMCA: duplicated middle cerebral artery; MRA: magnetic resonance angiography
Fig. 2
Fig. 2. Preoperative left internal carotid angiography (A: oblique position, B: 3D-DSA) showed an aneurysm, measuring 5.2 mm in maximum diameter, at the origin of duplicated middle cerebral artery. The DMCA had branched from the aneurysmal neck. 3D-DSA: thee-dimensional digital subtraction angiography; DMCA: duplicated middle cerebral artery
Fig. 3
Fig. 3. (A) At an intraoperative working angle, a Scepter C had been inserted into the aneurysmal neck. (B) Left internal carotid angiography (frontal view) immediately after surgery confirmed occlusion of the aneurysm, and preservation of the ICA and DMCA. (C) On left internal carotid angiography (lateral view) immediately after surgery, the anterior choroidal artery was visualized. White arrow: anterior choroidal artery. DMCA: duplicated middle cerebral artery; ICA: internal carotid artery
Fig. 4
Fig. 4. (A) Diffusion-weighted MRI the day after surgery did not show cerebral infarction. (B) On MRA the day after surgery, the aneurysm was not visualized. The ICA and DMCA were visible. DMCA: duplicated middle cerebral artery; ICA: internal carotid artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging
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