[Aneurysms associated with moyamoya angiopathy (clinical cases)]

The incidence of arterial aneurysms associated with moyamoya angiopathy (AA-MMA) is five times higher than in general population. The risk of AA-MMA rupture can reach 90%. AA-MMA clipping is accompanied by postoperative complications in 25% of cases, and endovascular treatment leads to a forced change of surgical tactic in 26% of cases. In this regard, it is relevant to discuss the features of surgery for AA-MMA and effective treatment algorithm.

To present rare clinical cases of AA-MMA and surgical treatment options.

The authors present two patients with ruptured AA-MMA. In the first case, there was a distal aneurysm of the right lenticulostriate artery associated with MMA (Suzuki III). The patient underwent aneurysm embolization followed by combined revascularization three months later. In the second case, aneurysm of ACA-AcomA complex was associated with contralateral MMA. The patient underwent microsurgical clipping of aneurysm and combined revascularization 1.5 months later.

These clinical cases demonstrate successful endovascular embolization and microsurgical treatment combined with delayed revascularization for the treatment of AA-MMA. In both cases, aneurysms were successfully removed. Perfusion improved after revascularization in both cases. There were no recurrent strokes throughout 2 years in the first case and 9 years in the second case.

AA-MMA is a complex pathology requiring special attention. Standard methods of surgical treatment are often associated with high risk of postoperative complications. Preoperative planning and consideration of pathogenic features of MMA are important.