Successful endovascular treatment of a ruptured saccular aneurysm arising from a fenestrated proximal anterior cerebral artery

Aneurysms arising from fenestrated proximal anterior cerebral arteries are rare. Previous studies primarily reported performing clipping. In contrast, endovascular treatment is rarely selected. In this report, we present a case of coil embolization for a ruptured aneurysm arising from a fenestrated proximal anterior cerebral artery. A sixty-five-year-old woman was transferred to the emergency department of our hospital owing to sudden onset of severe headache and vomiting. A head computed tomography scan showed a diffuse subarachnoid hemorrhage. A cerebral angiogram revealed an aneurysm at the fenestration of the A1 segment. Coil embolization of the aneurysm was performed, and the aneurysm was completely occluded. Both fenestration channels were preserved. The patient's clinical course was good, and she was discharged from the hospital twenty-six days after admission. Coil embolization of a ruptured aneurysm in the fenestration of the A1 segment was possible without sacrificing the parent arteries forming the fenestration. However, securing a working projection proved difficult due to the aneurysm being surrounded by two parent arteries forming the fenestration.