Large aneurysm of right PCA in Moya Moya disease

Patient

• 55-year-old male patient
• Known hypertension - poor compliance
• Severe headache for 8 days
• Plain CT brain - SAH

DSA

• Non-visualisation of both ICAs
• Large aneurysm of the right PCA
• Major supply from both vertebral arteries

Treatment options

• Neurosurgery¹
  • Clipping
  • Wrapping
• Endovascular
  • Flow diverter
  • Stent assisted coiling
  • Simple coiling

Simple coiling

• 6Fr femoral sheath
• Marksman microcatheter system
• 3 x coils
  • 1 x complex hydrophyl 6 x 10
  • 2 x complex 4.5 x 10 bare platinum

Moya Moya Disease

• Idiopathic condition, sometimes familial
• Incidence of 14 %²
• Major distribution along the circle of Willis³
• Associated large aneurysms are rare⁴
• Earlier, surgical treatment was the option
• Endovascular treatment

References

1. Zhang L, Xu K, Zhang Y, Wang X, Yu J. Treatment Strategies for Aneurysms Associated with Moyamoya Disease. Int J Med Sci [Internet]. 2015 Feb 5 [cited 2022 Aug 6];12(3):234 . Available from: /pmc/articles/PMC4323361/
2. Kawaguchi S, Sakaki T, Morimoto T, Kakizaki T, Kamada K. Characteristics of intracranial aneurysms associated with moyamoya disease. Acta Neurochir 1996 13811 [Internet]. 1996 [cited 2022 Aug 6];138(11):1287–94. Available from: https://link.springer.com/article/10.1007/BF01411057
3. A Bucciero BCLV. Giant basilar artery aneurysm associated with Moyamoya disease. Case report and review of the literature. Acta Neurol. 1994;16:121–8 .
4. Kim JH, Kwon TH, Kim JH, Chong K, Yoon W. Intracranial Aneurysms in Adult Moyamoya Disease. World Neurosurg [Internet]. 2018 Jan 1 [cited 2022 Aug 6];109:e175–82. Available from: https://pubmed.ncbi.nlm.nih.gov/28962951/

First reported by Japanese surgeons in 1957

• Uncommon cerebrovascular disease.
• Characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches.
• Associated with the development of dilated and fragile collateral vessels at the base of the brain.

Epidemiology

• Higher incidence in East Asia, and familial forms account for about 15 % of patients with this disease.
• Two peaks of age distribution at 5 years and 40 years. 

Etiology

• Still unknown
• Multifactorial inheritance is considered possible because of a higher incidence of the disease in Japanese and Koreans.