Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan.
Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
J Stroke Cerebrovasc Dis. 2021 Jul;30(7):105773. doi: 10.1016/j.jstrokecerebrovasdis.2021.105773. Epub 2021 Apr 15.
Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). Aneurysms at the origin of a DMCA have been reported; however, most have been treated with clipping surgery. Here, we describe two cases of aneurysms at the origin of a DMCA treated with coil embolization.
Case 1: A seventy-three year-old man presented with severe headache and was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) and 3-dimensional (3-D) DSA showed an aneurysm arising from a DMCA. Coil embolization was performed with DMCA patency. The patient had an uneventful postoperative course. CASE 1: A 44-year-old woman presented with a history of clipping for an IC-anterior choroidal artery (AchA) aneurysm 8 years prior. Magnetic resonance imaging (MRI) showed regrowth of the aneurysm. 3-D DSA showed an IC-DMCA aneurysm located laterally and distal to the AchA. The DMCA arose from the bottom of the aneurysm. Coil embolization was performed without DMCA occlusion and showed no postoperative ischemic changes.
An IC-DMCA aneurysm is rare and may be misdiagnosed as an AchA aneurysm. Clinicians should perform a 3D-DSA evaluation if the aneurysm arises from the lateral wall of the IC to obtain a precise diagnosis and to preserve the DMCA during coil embolization.
大脑中动脉（MCA）重复是一种起源于颈内动脉（ICA）的异常血管。已经报道了起源于 MCA 的动脉瘤；然而，大多数已通过夹闭手术治疗。在此，我们描述了两例起源于 MCA 的动脉瘤，通过线圈栓塞治疗。
病例 1：一名 73 岁男性因严重头痛就诊，被诊断为蛛网膜下腔出血（SAH）。数字减影血管造影（DSA）和三维（3-D）DSA 显示起源于 MCA 的动脉瘤。MCA 通畅性良好，进行了线圈栓塞。患者术后恢复顺利。病例 2：一名 44 岁女性，8 年前因 ICA-前交通动脉（AchA）动脉瘤行夹闭术。磁共振成像（MRI）显示动脉瘤复发。3-D DSA 显示位于 AchA 外侧和远端的 ICA-MCA 动脉瘤。MCA 起源于动脉瘤的底部。在不闭塞 MCA 的情况下进行线圈栓塞，无术后缺血性改变。
ICA-MCA 动脉瘤罕见，可能误诊为 AchA 动脉瘤。如果动脉瘤起源于 ICA 的外侧壁，临床医生应进行 3D-DSA 评估，以获得准确的诊断，并在进行线圈栓塞时保留 MCA。
