PMC4533376_01
(Case 1) Cerebral angiography before revascularization (A: right carotid artery, B: left carotid artery, C: vertebral artery) revealing a poorly depicted bilateral anterior cerebral artery (ACA) and right middle cerebral artery (MCA). Significant collateral vessels from the posterior cerebral artery to the territory of the ACA and MCA were found. A saccular aneurysm before revascularization had no bleb (D). The aneurysm after revascularization had multiple blebs (E). Cerebral angiography after revascularization (F: right carotid artery, G: left carotid artery, H: vertebral artery) found blood flow to the MCA territory by vessel anastomosis and unchanged posterior circulation. Coil embolization was performed and the aneurysm was obliterated (I).
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F1
A 48-year-old woman was diagnosed with moyamoya disease after experiencing a transient ischemic attack with left hemiparesis (Fig. 1A-C). Cerebral angiography revealed a saccular aneurysm at the bifurcation of the basilar artery and superior cerebellar artery (Fig. 1D). Seven months after revascularization, cerebral angiography revealed that the aneurysm had become enlarged (Fig. 1E). The angiography also showed that the donor vessels were able to sufficiently supplement circulation to the region supplied by the right MCA and that the posterior circulation was unchanged (Fig. 1-H).
PMC4533376_02
(Case 2) Cerebral angiography before revascularization (A: right carotid artery, B: left carotid artery, C: vertebral artery) revealing a poorly depicted bilateral anterior cerebral artery (ACA) and middle cerebral artery (MCA). Significant collateral vessels from the posterior cerebral artery to the territory of the ACA and MCA were found. Computed tomographic angiography upon initial admission revealed multiple aneurysms (posterior cerebral artery and posterior choroidal artery) (D). Computed tomography revealed a subarachnoid hemorrhage (E). Cerebral angiography after revascularization (F: right carotid artery, G: left carotid artery, H: vertebral artery) revealed blood flow in the territory of the MCA by bilateral vessel anastomosis and unchanged posterior circulation. The aneurysm of the posterior cerebral artery was enlarged and the aneurysm of the posterior choroidal artery was unchanged (I, J). Coil embolization was performed and the aneurysm was obliterated (K).
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F2
A 39-year-old woman developed intraventricular hemorrhage and was diagnosed with moyamoya disease (Fig. 2A-C). Computed tomographic angiography (CTA) revealed peripheral artery aneurysms at the right anterior choroidal artery and a saccular aneurysm at the right P1 portion of the posterior cerebral artery (PCA; Fig. 2D). Computed tomography revealed subarachnoid hemorrhage without intraventricular hemorrhage (Fig. 2E). CTA showed that the donor vessels were able to provide sufficient supplemental blood flow to the region supplied by both MCAs; however, it also revealed that the saccular aneurysm at the right P1 portion had become enlarged and that the peripheral artery aneurysms were unchanged (Fig. 2F-I). Coil embolization was performed under general anesthesia (Fig. 2J, K).