case_images: PMC11765619_01
case_images: Preoperative two-dimensional (2D) digital subtraction angiography. Frontal (left image) and Profile (right image) 2D DSA shows the two kissing aneurysms located at the bifurcation of the M1 segment of the right MCA. The white arrows indicate the precise location of the aneurysms, highlighting their proximity and shared arterial walls.
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case_images: Preoperative three-dimensional (3D) DSA rotational angiography. The 3D reconstruction of rotational DSA (left image) highlights the two kissing aneurysms (white arrows), one with 3 mm diameter and the other with a 7 mm diameter (right image).
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case_images: Preoperative 3D DSA rotational angiography. In a high-resolution image, two kissing aneurysms are seen on the bifurcation of the M1 segment of the right MCA. The white arrows indicate the aneurysms' distinct locations, emphasizing their close proximity and shared arterial structures, which are characteristic of this rare vascular anomaly.
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case_images: Postoperative CT scan. All three sections, transversal (left image), coronal (middle image), and sagittal (right image), show clip placement (white arrows) and sequelae from the ischemic stroke. The yellow arrows indicate areas of hypodensity corresponding to ischemic stroke sequelae in the right frontotemporal region.
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case_images: Intraluminal filling defects are observed in the pulmonary arteries supplying the basal pyramids and the medial segment of the middle lobe, with an appearance suggestive of pulmonary thromboembolism at this level (yellow arrows). Minimal passive subpleural atelectasis is noted bilaterally in the posterior-basal regions. No nodular expansive pulmonary lesions with a tumoral substrate are present. There are emphysematous bullae with a paraseptal apical distribution on the right side. No pleuro-pericardial fluid accumulations are observed. No mediastinal or axillary lymphadenopathy is detected bilaterally. The tracheobronchial tree is within normal limits. Intimal calcifications are present in the thoracic aorta.
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case_images: Two weeks after the surgical procedure, our patient experienced episodes of dyspnea due to pulmonary thromboembolism in both basal pyramids and the medial segment of the middle lobe (Figure 5).
case_images: Intraluminal filling defects in the pulmonary arteries are significantly reduced in both number and size, with a few small defects persisting in the pulmonary arteries supplying the antero- and mediobasal segments (yellow arrows). Small bilateral posterior-basal atelectases are noted, with a small pseudonodular area in the right basal region showing low iodophilia, which may suggest a small pulmonary infarction. The remainder of the findings are unchanged.
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case_images: Following a cardiology consultation, her anticoagulant therapy was switched to Xarelto 15 mg twice daily (Figure 6).
case_images: The CT scan conducted 3 months after the surgical procedure. All three sections, transversal (left image), coronal (middle image), and sagittal (right image), confirmed the right frontotemporal hypodensity consistent with ischemic stroke (yellow arrows) and noted artifacts from the previously placed aneurysm clips (white arrows).
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