Endovascular treatment using platinum coil of a peripheral artery aneurysm associated with moyamoya disease: case report

A 47-year-old man presented with the sudden onset of severe headache and left hemiplegia. CT showed a large hematoma in the right thalamus and internal capsule with intraventricular hemorrhage. Right carotid angiography disclosed occlusion of the terminal portion of the right internal carotid artery with moyamoya vessels and a small aneurysm at the perforator of the right anterior choroidal artery. The follow-up angiography 17 days later disclosed definite enlargement of the aneurysm. The aneurysm corresponded to the lateral portion of the hematoma on CT and was considered to be the source of bleeding. Endovascular embolization was performed using a platinum coil, and the aneurysm was completely occluded with preservation of the parent artery. No change in the patient's neurological status was seen during and after the procedure. The management of peripheral artery aneurysms associated with moyamoya disease is controversial. We suggest that surgical intervention should be considered if the aneurysm is thought to be the source of bleeding, and that endovascular embolization using platinum coils may be a useful therapeutic alternative for these aneurysms.