Intracranial dissection in the anterior circulation is relative rare, especially in the anterior cerebral artery (ACA), In addition, only several cases of ACA dissection that underwent endovascular treatment have been reported. Here we present a case of ACA dissection causing subarachnoid hemorrhage, successfully treated by tailored endovascular treatment (stent-protecting parent artery occlusion).
A 37-year-old man was admitted with sudden bursting headache which was followed by stuporous mentality. Computed tomography revealed subarachnoid hemorrhage and cerebral angiography showed fusiform dilatation from the right A1 to right A2, suggesting intracranial dissection.
Both carotid arteries were catheterized with two guiding catheters through bilateral transfemoral puncture under general anesthesia. First, one microcatheter through the left guiding catheter (Prowler select plus) was navigated from left A1 to right A2 and the stent (Enterprise 4mm x 30mm) was placed to protect A-com and right A2. The other microcatheter through right guiding catheter (Excelsior SL-10) was navigated into the dissected right A1 segment. The aneurysm along with the parent vessel (right A1) was occluded 10 coils. Angiography performed immediately after the procedure showed occlusion of the parent vessel with no filling of the aneurysm with patent flow of right A2. No ischemic complications were seen in the diffusion-weighted image. The two-month follow-up angiography did not show any recanalization.
To prevent ischemia in the territory fed by specific artery, tailored endovascular treatment, based on individual anatomic variation or lesion, should be considered and might be superior to simple parent artery occlusion.