Ruptured Distal Anterior Choroidal Artery Aneurysm Treated with Superselective Provocative Testing and Coil Embolization

Aneurysms of the anterior choroidal artery are uncommon, and distal anterior choroidal artery aneurysms are even rarer, with only 34 cases reported in the medical literature. These lesions have been most commonly reported in association with moyamoya disease or arteriovenous malformations. Most published experience with these aneurysms involves open surgical approaches. Reports of endovascular treatment have been in patients with lesions distal to the plexal point and have employed vessel occlusion with liquid embolic agents in preference to coil embolization. We present a case of a ruptured distal anterior choroidal artery aneurysm located on the cisternal segment of the artery. This lesion was successfully treated with endovascular coil embolization. Additionally, the patient underwent pre-embolization superselective provocative testing with amobarbital to assess the safety of parent vessel occlusion. Endovascular coil embolization for distal anterior choroidal artery aneurysms is technically feasible and may be preferable to embolization with liquid embolic agents for lesions proximal to the plexal point. This case illustrates the utility of provocative testing and efficacy of endovascular coil embolization for lesions in this unique location.