J Cerebrovasc Endovasc Neurosurg.  2015 Jun;17(2):108-112. 10.7461/jcen.2015.17.2.108.

Endovascular Treatment in Ruptured Middle Cerebral Artery Dissection Preservation of Arterial Continuity

Affiliations
  • 1Department of Neurosurgery, Kimpo Woori Hospital, Kimpo, Korea.
  • 2Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. contacting@lycos.co.kr

Abstract

Rupture of spontaneous dissecting aneurysms of the middle cerebral artery (MCA) is rare and its etiology remains obscure, although the risk of rebleeding is greater than with saccular aneurysms. Most reports concerning the treatment of a ruptured dissecting aneurysm of the anterior circulation involve surgical trapping or wrapping. Here, we report on a case of an MCA dissecting rupture treated with endovascular procedures. A 22-year-old female presented with sudden stuporous mental change following severe headache and left side hemiparesis. A computed tomography scan showed a diffuse subarachnoid hemorrhage and diffusion MR showed diffusion restriction at the right putamen and internal capsule. A 3-hour follow-up digital subtraction angiography (DSA) showed a dissecting aneurysm, which was not seen on an initial DSA. A stent assisted coil embolization was performed and double stents were applied to achieve flow diversion effects. A small remnant area of the dissecting aneurysm had disappeared at 60-day and was not observed on 12-month follow-up DSA.

Keyword

Dissecting aneurysm; Middle cerebral artery; Flow diversion; Stent assisted coil embolization

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Angiography, Digital Subtraction
Diffusion
Embolization, Therapeutic
Endovascular Procedures
Female
Follow-Up Studies
Headache
Humans
Internal Capsule
Middle Cerebral Artery*
Paresis
Putamen
Rupture
Stents
Stupor
Subarachnoid Hemorrhage
Young Adult
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