PMC7364793_01
(a) Preoperative axial CT demonstrating SAH. (b, c) Three-dimensional (3D) reconstructed CT angiogram showing a large IC-PC aneurysm with a bleb (arrow), and a right AChA branching from near the distal side of the aneurysm (arrow head).. *Right ICA; **right foetal type of PCA; ***right middle cerebral artery; and ****right anterior cerebral artery.
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Head computed tomography (CT) revealed an SAH, while CT arteriogram demonstrated a large IC-PC aneurysm with a bleb, a foetal type of posterior cerebral artery (PCA) branching the aneurysmal dome, and an AChA branching from the IC artery (ICA) near the distal side of the aneurysm, but not from the aneurysm (Figure 1).
Preoperative right ICA angiogram (lateral view) showing the foetal type of PCA branching from the contralateral aneurysmal dome of the bleb, and the hyperflexed AChA running on the surface of the aneurysm (arrowhead) (a: 3D-DSA, b: DSA). (c) Postoperative right ICA angiogram (lateral view) showing disappearance of the intra-aneurysmal flow following coil embolization, and patency of the right AChA.. *Right ICA; **right foetal type of PCA; and ***right middle cerebral artery.
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A hyperflexed AChA running on the surface of the aneurysm was also observed (Figure 2). PCA was spared. Postoperative DSA clearly revealed patency of the right AChA, without flow disturbance (Figure 2).
(a, b) Axial diffusion-weighted MRI on postoperative day 3 demonstrating residual SAH and areas of restricted diffusion in the right AChA territory, including the uncus, cerebral peduncle, and posterior limb of the internal capsule (arrow).
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Diffusion-weighted imaging of the brain showed high-signal-intensity lesions in the right uncus, cerebral peduncle, and the posterior limb of the internal capsule, representing an acute infarction in the territory of the right AChA, but no new high-intensity signals in other arterial territories (Figure 3).