Electrocoagulation treatment for patient with acute thalamoperforating artery pseudoaneurysm：a case report

Electrocoagulation treatment for patient with acute thalamoperforating artery pseudoaneurysm：a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Electrocoagulation treatment for patient with acute thalamoperforating artery pseudoaneurysm：a case report Xiaoping Zhou, Jun Liu, Guanlin Huang, Mingang Zou, Kun Hu, Xinyun Ye, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4827672/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Nov, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 16 You are reading this latest preprint version Abstract Background Thalamoperforating artery(TPA) pseudoaneurysms are relatively rare and can be difficult to detecte by vascular examination, and the treatment is challenging, especially in endovascular therapy. This article reports a relatively rare case of a patient with an acute thalamoperforating artery pseudoaneurysm. Case presentation A middle-aged man was admitted to our hospital with headache and vomiting and suffered a history of hypertension and heart surgery. The physical examination revealed that the neurological finding was significant only for neck stiffness. Initially, the left internal carotid aneurysm was found when the first subarachnoid hemorrhage emerged, and no other aneurysms were performed. Due to recurrent bleeding on the third day after embolization of the left ICA aneurysm, emergency angiography revealed a new thalamoperforating artery pseudoaneurysm. Following electrocoagulation endovascular treatment, the patient achieved a good recovery, and the aneurysm has not recurred. Conclusions Perforating artery aneurysm may not be detected on initial angiography, repeated angiography examinations are necessary. Electrocoagulation treatment of TPA pseudoaneurysm has not been previously reported. Electrocoagulation is a good alternative option when microcatheter could not be navigated into the aneurysm, but it needs to be noticed about the potential drawbacks. Thalamoperforating artery pseudoaneurysm Aneurysm Endovascular treatment Electrocoagulation Figures Figure 1 Figure 2 Introduction Thalamoperforating artery (TPA) pseudoaneurysms are relatively uncommon and hard to find in clinical treatment [ 1 ] . The mechanism is unclear, and the treatment is challenging. Surgical treatment methods include craniotomy and endovascular therapy. However, these procedures are difficult, and the outcomes are not optimistic, potentially causing permanent neurological deficits [ 2 ] . Electrocoagulation treatment of TPA pseudoaneurysms has not been previously reported. Here, we present a rare case of an acute TPA pseudoaneurysm treated with embolization using electrocoagulation endovascular therapy. Case presentation Patient information A 49-year-old Chinese male man was presented to our hospital with sudden headache and vomiting with a history of hypertension and a thoracotomy since a heart valve disease 18 years ago. He had no other cardiovascular risk factors. Clinical findings On admission, the patient had a blood pressure of 182/95 mmHg, a pulse of 94 beats per minute, a temperature of 36.9°C, a heart rate of 90 beats per minute, a respiratory rate of 17 breaths per minute, and an oxygen saturation of 98%. ECG and chest examination were normal, and laboratory tests indicated no infection. In addition, he has no specific genetic or family history, nor relevant social or contact history. Diagnostic evaluation The physical examination revealed that the neurological finding was significant only for neck stiffness. Initially, CT and initial CTA identified subarachnoid hemorrhage and a 3.5*2.5*2.5 mm saccular aneurysm of left ICA (Fig. 1 A and 1 B). Later, DSA confirmed no other aneurysms except for the left ICA aneurysm and a variant arch (Fig. 1 C, 1 D, and 1 E). After embolization of the left ICA aneurysm, DSA showed the aneurysm's disappearance while the left ICA and vital branches remained unobstructed (Fig. 1 F). Due to recurrent bleeding on the third day after embolization of the left ICA aneurysm, Emergency CT and vascular scans revealed new intracerebral hemorrhage and a TPA pseudoaneurysm (Fig. 2 A, 2 B), while the initial postoperative left ICA aneurysm did not appear. DSA confirmed that the TPA pseudoaneurysm was 2.5*2.5*2.0 mm, and its carrying vessel was approximately 0.4 mm (Fig. 2 C). Therapeutic intervention The patient underwent two interventional treatments. Initially, angiography showed subarachnoid hemorrhage and a left ICA aneurysm. The stent assisted three coils intervention for the treatment of the left ICA aneurysm. The day after surgery, the patient was administered aspirin (300 mg) and clopidogrel (300 mg) for the initial dose, followed by aspirin (100 mg) and clopidogrel (100 mg) per day. Due to recurrent bleeding after the first surgery, emergency angiography showed a new TPA pseudoaneurysm. The Marathon microcatheter (ev3, USA) was unable to advance into the aneurysm cavity after several attempts. The microcatheter was slowly pushed into the proximal to the P1 segment of the posterior cerebral artery near the aneurysm carrier vessel, and the Traxcess 14 guidewire (Microvention, USA) was inserted close to the aneurysm. The guidewire was then considered as the stent wire and connected to the Solitaire stent separation system (ev3, USA). Initially, electrocoagulation was performed at 1.0 V and 0.05 mA for two minutes, but the aneurysm persisted. Electrocoagulation was then continued for three more minutes, yet the aneurysm remained unchanged. The heat was increased to 1.0 V and 0.1 mA for two minutes, causing the aneurysm to shrink. Electrocoagulation was continued for about one more minute until the aneurysm completely disappeared (Fig. 2 D). Follow-up and outcomes The patient receiveed a good recovery experienced from this procedure. The patient was followed up with CT and angiography d(Fig. 2 E, 2 F, 2 G, 2 H) as well as telephone consultations. The patient has maintained a good recovery, and the aneurysm has not recurre. Discussion Aneurysms in the thalamoperforating artery (TPA) are very rare and can be difficult to detect by vascular imaging. Currently, several case reports have discussed TPA aneurysms [ 2 , 3 ] . Due to the lack of statistics from a large number of cases, the exact incidence rate is unknown. A pseudoaneurysm is a type of aneurysm that occurs when the entire blood vessel wall is damaged. There are various causes of pseudoaneurysms, which lack a normal blood vessel wall structure, making them prone to appearance, enlargement, and even rupture in a short term. The exact mechanisms underlying pseudoaneurysms are unclear; however, there are four main theories on its pathogenesis: vascular injury theory, long-term radiation-induced nerve cell death theory, autoimmune response theory, and free radical damage theory [ 4 ] . In addition, factors such as acute intractable hypertension, atherosclerosis, and drug use are considered susceptibility factors for pseudoaneurysms [ 5 ] . In this case, the patient had no recent history of trauma, and the initial surgical intervention did not reach the vicinity of the TPA aneurysm. Therefore, traumatic and iatrogenic causes can be excluded. Secondly, the TPA aneurysm was not detected during the initial surgery but appeared on the third day after embolization of the left ICA aneurysm. This phenomenon of TPA aneurysm occurred within a short time frame. Usually, aneurysms are common in patients aged 30–60 or older, but the patient we observed was younger. Furthermore, multiple susceptibility factors were considered, such as short-term acute hypertension, atherosclerosis, and the use of antiplatelet aggregation and vasospasm-resisting drugs. Thus, it is believed that this patient suffered from a pseudoaneurysm, with the following suspected reasons: The patient's vascular wall was chronically damaged by early-stage atherosclerosis. When the blood pressure suddenly rose, the vascular wall structure deteriorated further in the short term. In addition, medication (antiplatelet aggregation and vasospasm-resisting drugs) and aortic arch variation malformation were important contributing factors. The combination of these factors led to the formation of an acute pseudoaneurysm, which is consistent with the vascular injury theory. Further experimental verification is needed to fully understand the underlying mechanism. It is noteworthy that TPA pseudoaneurysms may not be detected on initial angiography. Hence, repeated angiographic examinations are necessary. Reports on the treatment of TPA pseudoaneurysms are rare and challenging, with only a few case reports presented [ 4 – 6 ] . Some patients undergo conservative drug treatment due to the existence of perforators, which supply blood to neural structures. However, recurrent bleeding can occur during the acute or subacute period, potentially causing permanent neurological dysfunction [ 1 , 3 , 5 ] . To prevent recurrent bleeding, it is necessary to operate on the ruptured blood vessel. Surgical procedures include craniotomy and endovascular therapy. Endovascular therapy is preferred due to its advantage of accessing deep lesion locations with minimal invasion. Hamel et al. reported that the guidance of a microcatheter into the aneurysm failed, necessitating surgical clipping instead of endovascular therapy. This resulted in tension pneumocephalus and midbrain infarction [ 6 ] . Peschillo et al. showed that three patients received intravascular treatment with flow-diverter stents, one of which resulted in death [ 7 ] . In summary, the surgical procedures are challenging, and the outcomes often do not yield optimistic results. In this case, due to the TPA pseudoaneurysm being 2.5 mm in size and its carrying vessel approximately 0.4 mm, we failed to maneuver the microcatheter into the aneurysm after several attempts. The standard surgical approach to address the aneurysm was difficult to complete. Yuhua Jiang et al. performed a PICA aneurysm that was successfully completed with electrocoagulation due to the inability of microcatheters to enter [ 8 ] . We adopted a similar electrocoagulation method. However, this technology has potential drawbacks. One is that electrocoagulation heat may extend beyond the aneurysm wall and affect surrounding tissues, causing nearby peripheral nerve damage. Another potential drawback is that thrombus or heat-induced adhesions may tear blood vessels when removing the aneurysm catheter. Additionally, its durability is uncertain. Therefore, we tried to advance the microcatheter near the aneurysm carrier vessel, placed microwires close to the aneurysm, and then used the guide wire as the stent wire, connecting it to the Solitaire stent separation system. Electrocoagulation was performed. We used microwires to conduct heat and electrocoagulate the aneurysm, attempting different heat and electrocoagulation times to achieve effective treatment. Fortunately, the aneurysm was not visible. The patient performed no complications after this treatment and was observed with CT and angiography. The patient has recovered well, and the aneurysm has not recurred.Electrocoagulation offers a specific treatment approach when a microcatheter cannot be guided to the aneurysm. However, some main concerns about this endovascular technique should be noted, including electrocoagulation heat magnitude and timing control, the timing of catheter withdrawal, and its durability. Currently, electrocoagulation treatment of TPA pseudoaneurysm has not been previously reported, and we are limited to an individual case for this specific technique. More importantly, the long-term durability of this technique needs to be monitored through follow-up. Conclusion Perforating artery aneurysms are not easy to be discovered and repeated angiographic examinations are necessary. Electrocoagulation treatment of TPA pseudoaneurysm has not been previously reported. Electrocoagulation is a good alternative option when a microcatheter cannot be navigated into the aneurysm, but potential drawbacks need to be considered. Abbreviations TPA=Thalamoperforating artery; ICA=Internal carotid artery; CTA=Computed tomography angiography; DSA=Digital subtraction angiography; PCA=Posterior cerebral artery Declarations Acknowledgements Not applicable. Author contributions XPZ and QHJ were major contributors to the conception and design of the work and in reviewing the manuscript. GLH, JL, MGZ, KH,XYY and ZYZ were major contributors to reviewing and analyzing medical records. XPZ, JL, and GLH were major contributors to writing the article. QHJ was a major contributor tothe critical revision of the article. All authors have read and approved the final manuscript. Funding None. Data availability No datasets were generated or analysed during the current study. Ethics approval and consent to participate The study protocols were approved by the Ethical Committee of the Ganzhou People’s Hospital. Written consent to participate was obtained. Consent for publication Written Informed Consent was obtained from the patient for the publication of the Case report and accompanying images. Competing interests The authors declare no competing interests. References Ding D, Starke RM, Jensen ME, Evans AJ, Kassell NF, Liu KC. Perforator aneurysms of the posterior circulation: case series andreview of the literature. J Neurointerv Surg. 2013;5(6):546–51. Chavent A, Lefevre PH, Thouant P, et al. Spontaneous resolution of perforator aneurysms of the posterior circulation. J Neurosurg. 2014;121(5):1107–11. Kaya AH, Dagcinar A, Ulu MO, et al. The perforating branches of the P1 segment of the posterior cerebral artery. J Clin Neurosci. 2010;17(1):80–4. Tia Chakraborty W, Brinjikji G, Lanzino, et al. Acute Pseudoaneurysms and Hemorrhage After Transcarotid Artery Revascularization. Clin Pract June. 2021 vol;11(3):e370–2. Koueik J, Larson S, Ahmed A, Hanna AS. Large vertebral artery pseudoaneurysm masquerading as a schwannoma: illustrative case. J Neurosurg Case Lessons. 2023;6(1). Hamel W, Grzyska U, Westphal M, Kehler. U.Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir(Wien). 2005;147:1283–6. Peschillo S, Caporlingua A, Cannizzaro D, et al. Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms. J Neurointerv Surg. 2016;8:190–6. Jiang Y. Endovascular pure electrocoagulation of intracranial perforator blister-like aneurysm not accessible to microcatheter—New approach to treat small vessel hemorrhage disease. J Int J Stroke. 2016;11(5):NP60–1. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Nov, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 04 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviewers agreed at journal 31 Jul, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviews received at journal 23 Jul, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviews received at journal 06 Jul, 2025 Reviewers agreed at journal 05 Jul, 2025 Reviewers agreed at journal 30 Jun, 2025 Reviews received at journal 11 Jan, 2025 Reviewers agreed at journal 08 Jan, 2025 Reviewers invited by journal 28 Aug, 2024 Editor invited by journal 02 Aug, 2024 Editor assigned by journal 31 Jul, 2024 Submission checks completed at journal 31 Jul, 2024 First submitted to journal 30 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4827672","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":344702642,"identity":"93e4a67a-9c65-44e1-844c-2d9147994373","order_by":0,"name":"Xiaoping Zhou","email":"","orcid":"","institution":"Ganzhou People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoping","middleName":"","lastName":"Zhou","suffix":""},{"id":344702643,"identity":"ce5a83bb-807d-48d7-9d06-e11dd2232006","order_by":1,"name":"Jun Liu","email":"","orcid":"","institution":"Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Liu","suffix":""},{"id":344702644,"identity":"ed9e113e-55b7-4260-889f-05fb32fbc3b5","order_by":2,"name":"Guanlin Huang","email":"","orcid":"","institution":"Ganzhou People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guanlin","middleName":"","lastName":"Huang","suffix":""},{"id":344702645,"identity":"1abda6c3-3c4a-4f19-83eb-f6b554aedc42","order_by":3,"name":"Mingang Zou","email":"","orcid":"","institution":"Ganzhou People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mingang","middleName":"","lastName":"Zou","suffix":""},{"id":344702646,"identity":"eb4f752c-3039-4ea5-9dc3-9e0854cc9001","order_by":4,"name":"Kun Hu","email":"","orcid":"","institution":"Ganzhou People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kun","middleName":"","lastName":"Hu","suffix":""},{"id":344702647,"identity":"48534893-785b-41c1-aaa0-01d90565c6ca","order_by":5,"name":"Xinyun Ye","email":"","orcid":"","institution":"Ganzhou People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xinyun","middleName":"","lastName":"Ye","suffix":""},{"id":344702648,"identity":"e80c956a-a423-45e3-9e6a-9a04ff7896b9","order_by":6,"name":"Zhenyu Zhang","email":"","orcid":"","institution":"Ganzhou People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhenyu","middleName":"","lastName":"Zhang","suffix":""},{"id":344702649,"identity":"b3a73caf-0752-4efd-9a3f-0ad57f1d42c9","order_by":7,"name":"Qiuhua Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYBACxmYwdYCHn7354IOEChvitchI9hxLNnhwJo1oyw7YGNzwMZN82HaIsFrmduZnD7+U3eExuMGWVpHAdoCBv707gYDD2MyNZc4945G83XzsRgLPHQaJM2c3ENDCYCYt2XaYh+/OsbQbCRLPGAwkcglpYf8G1sJwI8esIMHgMDFaeMwkPwK1CAC1MCQkEKelTJrh3GEeUCBLJBxI4yHoF8P+49skf5QdtgdF5cef/2zk+Nt7CWhpAAY0DxtCgAevchCQBznuBxtBdaNgFIyCUTCSAQCeWE6RuRnATQAAAABJRU5ErkJggg==","orcid":"","institution":"Ganzhou People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Qiuhua","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2024-07-30 09:50:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4827672/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4827672/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-025-05265-8","type":"published","date":"2025-11-14T15:57:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64005731,"identity":"056ba901-dacc-40d9-85a4-c3201ef362c5","added_by":"auto","created_at":"2024-09-04 21:40:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":419356,"visible":true,"origin":"","legend":"\u003cp\u003eA: CT showed subarachnoid hemorrhage. B: CTA revealed a left ICA aneurysm (red arrows). C-E: DSA confirmed that no other aneurysms were found except for the left ICA aneurysm (red arrows) and variant arch (C). F: The left ICA aneurysm was embolized using stent-assisted coils.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4827672/v1/fe4ed8913035e86fba56b46e.png"},{"id":64006190,"identity":"56e0100b-f629-429c-a709-cd4bd10c5f24","added_by":"auto","created_at":"2024-09-04 21:48:11","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":308430,"visible":true,"origin":"","legend":"\u003cp\u003eA: CT showed subarachnoid hemorrhage around the midbrain and anterior to the pons. B: CTA revealed a left thalamoperforating artery aneurysm (yellow circle). C: DSA confirmed a left thalamoperforating artery aneurysm measuring 2.5 mm (yellow circle). D: The left thalamoperforating artery aneurysm (yellow circle) completely disappeared after electrocoagulation endovascular therapy. E: One-month follow-up image of DSA. F: One-year follow-up image of CTA. G-H: One-year follow-up images of CT.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4827672/v1/f3dca1090266d0ce6abbeccc.jpeg"},{"id":96105018,"identity":"d50af2dc-c54d-443c-942c-73934bdb42a3","added_by":"auto","created_at":"2025-11-17 16:07:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1140131,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4827672/v1/b772f0d1-cc0d-4538-9307-d209b3ae1466.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Electrocoagulation treatment for patient with acute thalamoperforating artery pseudoaneurysm：a case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThalamoperforating artery (TPA) pseudoaneurysms are relatively uncommon and hard to find in clinical treatment \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The mechanism is unclear, and the treatment is challenging. Surgical treatment methods include craniotomy and endovascular therapy. However, these procedures are difficult, and the outcomes are not optimistic, potentially causing permanent neurological deficits \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Electrocoagulation treatment of TPA pseudoaneurysms has not been previously reported. Here, we present a rare case of an acute TPA pseudoaneurysm treated with embolization using electrocoagulation endovascular therapy.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient information\u003c/h2\u003e \u003cp\u003eA 49-year-old Chinese male man was presented to our hospital with sudden headache and vomiting with a history of hypertension and a thoracotomy since a heart valve disease 18 years ago. He had no other cardiovascular risk factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Clinical findings","content":"\u003cp\u003eOn admission, the patient had a blood pressure of 182/95 mmHg, a pulse of 94 beats per minute, a temperature of 36.9\u0026deg;C, a heart rate of 90 beats per minute, a respiratory rate of 17 breaths per minute, and an oxygen saturation of 98%. ECG and chest examination were normal, and laboratory tests indicated no infection. In addition, he has no specific genetic or family history, nor relevant social or contact history.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDiagnostic evaluation\u003c/h2\u003e \u003cp\u003eThe physical examination revealed that the neurological finding was significant only for neck stiffness. Initially, CT and initial CTA identified subarachnoid hemorrhage and a 3.5*2.5*2.5 mm saccular aneurysm of left ICA (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Later, DSA confirmed no other aneurysms except for the left ICA aneurysm and a variant arch (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC, \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD, and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eE). After embolization of the left ICA aneurysm, DSA showed the aneurysm's disappearance while the left ICA and vital branches remained unobstructed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF). Due to recurrent bleeding on the third day after embolization of the left ICA aneurysm, Emergency CT and vascular scans revealed new intracerebral hemorrhage and a TPA pseudoaneurysm (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB), while the initial postoperative left ICA aneurysm did not appear. DSA confirmed that the TPA pseudoaneurysm was 2.5*2.5*2.0 mm, and its carrying vessel was approximately 0.4 mm (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTherapeutic intervention\u003c/h2\u003e \u003cp\u003eThe patient underwent two interventional treatments. Initially, angiography showed subarachnoid hemorrhage and a left ICA aneurysm. The stent assisted three coils intervention for the treatment of the left ICA aneurysm. The day after surgery, the patient was administered aspirin (300 mg) and clopidogrel (300 mg) for the initial dose, followed by aspirin (100 mg) and clopidogrel (100 mg) per day. Due to recurrent bleeding after the first surgery, emergency angiography showed a new TPA pseudoaneurysm. The Marathon microcatheter (ev3, USA) was unable to advance into the aneurysm cavity after several attempts. The microcatheter was slowly pushed into the proximal to the P1 segment of the posterior cerebral artery near the aneurysm carrier vessel, and the Traxcess 14 guidewire (Microvention, USA) was inserted close to the aneurysm. The guidewire was then considered as the stent wire and connected to the Solitaire stent separation system (ev3, USA). Initially, electrocoagulation was performed at 1.0 V and 0.05 mA for two minutes, but the aneurysm persisted. Electrocoagulation was then continued for three more minutes, yet the aneurysm remained unchanged. The heat was increased to 1.0 V and 0.1 mA for two minutes, causing the aneurysm to shrink. Electrocoagulation was continued for about one more minute until the aneurysm completely disappeared (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up and outcomes\u003c/h2\u003e \u003cp\u003eThe patient receiveed a good recovery experienced from this procedure. The patient was followed up with CT and angiography d(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eG,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eH) as well as telephone consultations. The patient has maintained a good recovery, and the aneurysm has not recurre.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAneurysms in the thalamoperforating artery (TPA) are very rare and can be difficult to detect by vascular imaging. Currently, several case reports have discussed TPA aneurysms \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Due to the lack of statistics from a large number of cases, the exact incidence rate is unknown.\u003c/p\u003e \u003cp\u003eA pseudoaneurysm is a type of aneurysm that occurs when the entire blood vessel wall is damaged. There are various causes of pseudoaneurysms, which lack a normal blood vessel wall structure, making them prone to appearance, enlargement, and even rupture in a short term. The exact mechanisms underlying pseudoaneurysms are unclear; however, there are four main theories on its pathogenesis: vascular injury theory, long-term radiation-induced nerve cell death theory, autoimmune response theory, and free radical damage theory \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. In addition, factors such as acute intractable hypertension, atherosclerosis, and drug use are considered susceptibility factors for pseudoaneurysms \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In this case, the patient had no recent history of trauma, and the initial surgical intervention did not reach the vicinity of the TPA aneurysm. Therefore, traumatic and iatrogenic causes can be excluded. Secondly, the TPA aneurysm was not detected during the initial surgery but appeared on the third day after embolization of the left ICA aneurysm. This phenomenon of TPA aneurysm occurred within a short time frame. Usually, aneurysms are common in patients aged 30\u0026ndash;60 or older, but the patient we observed was younger. Furthermore, multiple susceptibility factors were considered, such as short-term acute hypertension, atherosclerosis, and the use of antiplatelet aggregation and vasospasm-resisting drugs. Thus, it is believed that this patient suffered from a pseudoaneurysm, with the following suspected reasons: The patient's vascular wall was chronically damaged by early-stage atherosclerosis. When the blood pressure suddenly rose, the vascular wall structure deteriorated further in the short term. In addition, medication (antiplatelet aggregation and vasospasm-resisting drugs) and aortic arch variation malformation were important contributing factors. The combination of these factors led to the formation of an acute pseudoaneurysm, which is consistent with the vascular injury theory. Further experimental verification is needed to fully understand the underlying mechanism. It is noteworthy that TPA pseudoaneurysms may not be detected on initial angiography. Hence, repeated angiographic examinations are necessary.\u003c/p\u003e \u003cp\u003eReports on the treatment of TPA pseudoaneurysms are rare and challenging, with only a few case reports presented \u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Some patients undergo conservative drug treatment due to the existence of perforators, which supply blood to neural structures. However, recurrent bleeding can occur during the acute or subacute period, potentially causing permanent neurological dysfunction \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. To prevent recurrent bleeding, it is necessary to operate on the ruptured blood vessel. Surgical procedures include craniotomy and endovascular therapy. Endovascular therapy is preferred due to its advantage of accessing deep lesion locations with minimal invasion. Hamel et al. reported that the guidance of a microcatheter into the aneurysm failed, necessitating surgical clipping instead of endovascular therapy. This resulted in tension pneumocephalus and midbrain infarction \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Peschillo et al. showed that three patients received intravascular treatment with flow-diverter stents, one of which resulted in death \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. In summary, the surgical procedures are challenging, and the outcomes often do not yield optimistic results. In this case, due to the TPA pseudoaneurysm being 2.5 mm in size and its carrying vessel approximately 0.4 mm, we failed to maneuver the microcatheter into the aneurysm after several attempts. The standard surgical approach to address the aneurysm was difficult to complete. Yuhua Jiang et al. performed a PICA aneurysm that was successfully completed with electrocoagulation due to the inability of microcatheters to enter \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. We adopted a similar electrocoagulation method. However, this technology has potential drawbacks. One is that electrocoagulation heat may extend beyond the aneurysm wall and affect surrounding tissues, causing nearby peripheral nerve damage. Another potential drawback is that thrombus or heat-induced adhesions may tear blood vessels when removing the aneurysm catheter. Additionally, its durability is uncertain. Therefore, we tried to advance the microcatheter near the aneurysm carrier vessel, placed microwires close to the aneurysm, and then used the guide wire as the stent wire, connecting it to the Solitaire stent separation system. Electrocoagulation was performed. We used microwires to conduct heat and electrocoagulate the aneurysm, attempting different heat and electrocoagulation times to achieve effective treatment. Fortunately, the aneurysm was not visible. The patient performed no complications after this treatment and was observed with CT and angiography. The patient has recovered well, and the aneurysm has not recurred.Electrocoagulation offers a specific treatment approach when a microcatheter cannot be guided to the aneurysm. However, some main concerns about this endovascular technique should be noted, including electrocoagulation heat magnitude and timing control, the timing of catheter withdrawal, and its durability. Currently, electrocoagulation treatment of TPA pseudoaneurysm has not been previously reported, and we are limited to an individual case for this specific technique. More importantly, the long-term durability of this technique needs to be monitored through follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePerforating artery aneurysms are not easy to be discovered and repeated angiographic examinations are necessary. Electrocoagulation treatment of TPA pseudoaneurysm has not been previously reported. Electrocoagulation is a good alternative option when a microcatheter cannot be navigated into the aneurysm, but potential drawbacks need to be considered.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTPA=Thalamoperforating artery; ICA=Internal carotid artery; CTA=Computed tomography angiography; \u0026nbsp;DSA=Digital subtraction angiography; \u0026nbsp;PCA=Posterior cerebral artery\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXPZ and QHJ were major contributors to the conception and design of the work and in reviewing the manuscript. GLH, JL, MGZ, KH,XYY and ZYZ were major contributors to reviewing and analyzing medical records. XPZ, JL, and GLH were major contributors to writing the article. QHJ was a major contributor tothe critical revision of the article. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocols were approved by the Ethical Committee of the Ganzhou People\u0026rsquo;s Hospital. Written consent to participate was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten Informed Consent was obtained from the patient for the publication of the Case report and accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDing D, Starke RM, Jensen ME, Evans AJ, Kassell NF, Liu KC. Perforator aneurysms of the posterior circulation: case series andreview of the literature. J Neurointerv Surg. 2013;5(6):546\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChavent A, Lefevre PH, Thouant P, et al. Spontaneous resolution of perforator aneurysms of the posterior circulation. J Neurosurg. 2014;121(5):1107\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaya AH, Dagcinar A, Ulu MO, et al. The perforating branches of the P1 segment of the posterior cerebral artery. J Clin Neurosci. 2010;17(1):80\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTia Chakraborty W, Brinjikji G, Lanzino, et al. Acute Pseudoaneurysms and Hemorrhage After Transcarotid Artery Revascularization. Clin Pract June. 2021 vol;11(3):e370\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoueik J, Larson S, Ahmed A, Hanna AS. Large vertebral artery pseudoaneurysm masquerading as a schwannoma: illustrative case. J Neurosurg Case Lessons. 2023;6(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamel W, Grzyska U, Westphal M, Kehler. U.Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir(Wien). 2005;147:1283\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeschillo S, Caporlingua A, Cannizzaro D, et al. Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms. J Neurointerv Surg. 2016;8:190\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang Y. Endovascular pure electrocoagulation of intracranial perforator blister-like aneurysm not accessible to microcatheter\u0026mdash;New approach to treat small vessel hemorrhage disease. J Int J Stroke. 2016;11(5):NP60\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Thalamoperforating artery pseudoaneurysm, Aneurysm, Endovascular treatment, Electrocoagulation","lastPublishedDoi":"10.21203/rs.3.rs-4827672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4827672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThalamoperforating artery(TPA) pseudoaneurysms are relatively rare and can be difficult to detecte by vascular examination, and the treatment is challenging, especially in endovascular therapy. This article reports a relatively rare case of a patient with an acute thalamoperforating artery pseudoaneurysm.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eA middle-aged man was admitted to our hospital with headache and vomiting and suffered a history of hypertension and heart surgery. The physical examination revealed that the neurological finding was significant only for neck stiffness. Initially, the left internal carotid aneurysm was found when the first subarachnoid hemorrhage emerged, and no other aneurysms were performed. Due to recurrent bleeding on the third day after embolization of the left ICA aneurysm, emergency angiography revealed a new thalamoperforating artery pseudoaneurysm. Following electrocoagulation endovascular treatment, the patient achieved a good recovery, and the aneurysm has not recurred.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePerforating artery aneurysm may not be detected on initial angiography, repeated angiography examinations are necessary. Electrocoagulation treatment of TPA pseudoaneurysm has not been previously reported. Electrocoagulation is a good alternative option when microcatheter could not be navigated into the aneurysm, but it needs to be noticed about the potential drawbacks.\u003c/p\u003e","manuscriptTitle":"Electrocoagulation treatment for patient with acute thalamoperforating artery pseudoaneurysm：a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 21:40:06","doi":"10.21203/rs.3.rs-4827672/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-04T04:58:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T04:47:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73386835601640909387000796762571870551","date":"2025-07-31T09:35:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-07-28T14:55:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-23T22:26:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260213394802975184159665688428434391027","date":"2025-07-23T19:36:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-06T06:41:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171829899850440324473217352318791506517","date":"2025-07-06T03:16:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21537962601494020909560844040193212681","date":"2025-06-30T16:16:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-11T05:50:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171927978353624977069644167099746726890","date":"2025-01-08T22:38:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-28T20:57:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-02T17:56:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-31T14:19:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-31T14:18:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2024-07-30T09:48:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba0e7bfd-3aa4-4f0f-8519-ff08a78e72a2","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:00:55+00:00","versionOfRecord":{"articleIdentity":"rs-4827672","link":"https://doi.org/10.1186/s12872-025-05265-8","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2025-11-14 15:57:38","publishedOnDateReadable":"November 14th, 2025"},"versionCreatedAt":"2024-09-04 21:40:06","video":"","vorDoi":"10.1186/s12872-025-05265-8","vorDoiUrl":"https://doi.org/10.1186/s12872-025-05265-8","workflowStages":[]},"version":"v1","identity":"rs-4827672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4827672","identity":"rs-4827672","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}