J Cerebrovasc Endovasc Neurosurg.  2016 Jun;18(2):110-114. 10.7461/jcen.2016.18.2.110.

Hemodynamic Impact of a Spontaneous Cervical Dissection on an Ipsilateral Saccular Aneurysm

• See AP
• Gross BA
• Penn DL
• Du R
• Frerichs K

• KMID: 2354885
• DOI: http://doi.org/10.7461/jcen.2016.18.2.110

Abstract

The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.

Keyword

Aneurysm; Endovascular; Dissection; Saccular aneurysm; Thrombosis

MeSH Terms

Aneurysm*
Aneurysm, False
Carotid Artery, Internal
Carotid Artery, Internal, Dissection
Female
Hemodynamics*
Humans
Intracranial Aneurysm
Magnetic Resonance Imaging
Middle Aged
Retrospective Studies
Thrombosis

Figure

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  Fig. 1 CTA demonstrates a cervical left internal carotid artery dissection (arrow, sagittal, left panel) and a 4 mm left supraclinoid aneurysm (sagittal, right panel, arrow). CTA = computed tomography angiography.

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  Fig. 2 Scheduled follow-up CTA at 4 months redemonstrates the left supraclinoid aneurysm with significant increase in contrast filling compared to the prior CTA; it is now measured at 10 mm. CTA = computed tomography angiography.

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  Fig. 3 Digital subtraction angiography for further evaluation of the dissection and aneurysm demonstrates a healed left ICA dissection (A, lateral view of common carotid artery injection) and an irregular, 9.8 × 6.2 mm posterior communicating artery aneurysm (B, lateral view of common carotid artery injection); C, 3D-reconstruction. ICA = internal carotid artery.

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  Fig. 4 Axial T1 MRI demonstrates thrombus posterior to the communicating segment of the left internal carotid artery (left panel). Sagittal T1 MRI demonstrates thrombus inferior to the communicating segment of the left internal carotid artery, similar in morphology to the aneurysm seen in Fig. 3A (right panel). MRI = magnetic resonance imaging.

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  Fig. 5 Left panel: Lateral projection of the left internal carotid injection demonstrates coil pack within aneurysm. Right panel: Lateral projection of a subtracted image of the left internal carotid injection.

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