case_images: PMC11225498_01
case_images: Imaging studies before treatment. (a) Anteroposterior view of MRA, (b) anteroposterior view of 3DR-DSA, (c) left-right view of 3DR-DSA, and (d) posteroanterior view of 3DR-DSA. MRA suggested an aneurysm (square in a) at the origin of the left MCA. The aneurysm with irregular configuration protruded anteriorly and posteriorly through the ring composed of two limbs of DOMA on 3DRDSA images (b-d). Square: Supposed aneurysm on MRA: Magnetic resonance angiography, ICA: internal carotid artery, ATA: Anterior temporal artery, Ach: Anterior choroidal artery, LSA: lenticulostriate artery, SL: superior limb of DOMA, IL: inferior limb of DOMA, Pcom: posterior communicating artery, Arrowhead: fusing point of two limbs of DOMA, Yellow arrow: Anterior projection of aneurysm, Blue arrow: posterior projection of aneurysm, 3DR-DSA: Three-dimensional reconstruction image of digital subtraction angiography, MCA: Middle cerebral artery, DOMA: Duplicate origin of middle cerebral artery. A1 and A2: A1 and A2 portion of anterior cerebral artery, M1 and M2: M1 and M2 portion of middle cerebral artery.
case_images: SNI-15-194-g001.jpg
case_images: PMC11225498_01_SNI-15-194-g001.jpg
case_images: F1
case_images: An otherwise healthy 42-year-old woman suffering transient vertigo underwent magnetic resonance imaging (MRI), which did not show any causative condition for the symptom, whereas MRA found an aneurysm, 8 mm in the largest diameter, at the origin of the left MCA [Figure 1a]. Moreover, the aneurysm arose from the corner between the ICA and the inferior limb [Figures 1b-d].
case_images: DSA of the left internal carotid artery during coil embolization. (a) Anteroposterior view of road mapping image during embolization, (b) right-left view of road mapping image during embolization, (c) anteroposterior view of DSA after the embolization, and (d) right-left view of DSA after the embolization. The tip of the coil inadvertently migrated into the upper limb through the lower limb of DOMA at the initial stage of framing (a and b). Complete obliteration of the aneurysm was achieved (c and d). Asterisk: Aneurysmal sac. ICA: Internal carotid artery, SL: Superior limb of DOMA, IL: Inferior limb of DOMA, ATA: Anterior temporal artery, Yellow arrow: Anterior projection of aneurysm, Blue arrow: Posterior projection of aneurysm, DOMA: Duplicate origin of middle cerebral artery, DSA: Digital subtraction angiography. A2: A2 portion of anterior cerebral artery, M2: M2 portion of middle cerebral artery.
case_images: SNI-15-194-g002.jpg
case_images: PMC11225498_01_SNI-15-194-g002.jpg
case_images: F2
case_images: After the second loop of the framing coil was deployed, the tip of the coil was found inadvertently advanced into the inferior limb and then into the superior limb through the distal fusion point of the ring [Figures 2a and b]. Two more coils, Optimax Complex Soft   4 mm x 7 mm (Balt LLC, USA) and Optima Complex-10 Super Soft  2 mm x 4 mm (Balt LLC, USA), were inserted into the sac through the jailed microcather-2, which eventually led to complete occlusion of the aneurysm (Raymond-Roy class 1) [Figures 2c and d].
case_images: DSA of the left internal carotid artery performed 3 months after the coil embolization. (a) Anteroposterior view, and (b) right-left view. The aneurysmal sac was completely obliterated, demonstrating Raymond-roy occlusion class I. Asterisk: Aneurysmal sac, DSA: Digital subtraction angiography.
case_images: SNI-15-194-g003.jpg
case_images: PMC11225498_01_SNI-15-194-g003.jpg
case_images: F3