- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
DOI:10.4103/2152-7806.171240Copyright: © 2015 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Iwasaki M, Hattori I, Sasaki M, Ishimori H, Nemoto A, Hikita C, Sato J, Fukuta S, Morimoto M. Stent-assisted coil embolization for anterior cerebral artery dissection presented with cerebral infarction. Surg Neurol Int 07-Dec-2015;6:182
How to cite this URL: Iwasaki M, Hattori I, Sasaki M, Ishimori H, Nemoto A, Hikita C, Sato J, Fukuta S, Morimoto M. Stent-assisted coil embolization for anterior cerebral artery dissection presented with cerebral infarction. Surg Neurol Int 07-Dec-2015;6:182. Available from: http://surgicalneurologyint.com/surgicalint_articles/stent%e2%80%91assisted-coil-embolization-for-anterior-cerebral-artery-dissection-presented-with-cerebral-infarction/
Background:Compared to those found in the vertebrobasilar system, intracranial dissection in the anterior circulation is relatively rare, especially in the anterior cerebral artery (ACA). Moreover, only several cases of ACA dissection that underwent endovascular treatment have been reported. Here we present a rare case of gradually developing ACA dissecting aneurysm causing cerebral infarction, successfully treated by stent-assisted coil embolization.
Case Description:A 36-year-old man was admitted with sudden right hemiparesis. Diffusion-weighted magnetic resonance (MR) imaging showed cerebral infarction in the left ACA territory, and MR angiography showed segmental stenosis at the A2 portion of the left ACA. Three-dimensional digital subtraction angiogram showed segmental dilatation and stenosis at the left A2 portion. We diagnosed ACA dissection causing acute cerebral infarction and treated the patient conservatively. Five months after the onset, the dissecting artery at the left A2 portion formed a gradually dilating aneurysm, suggesting increased risk for aneurysmal rupture. We attempted endovascular treatment entailing coil embolization of an aneurysm while preserving the left A2 with stent assistance. The patient remained neurologically stable 6 months after the procedure.
Conclusions:Although there are few reported cases of ACA dissection where endovascular treatment was attempted, we consider stent-assisted embolization for gradually developing ACA dissecting aneurysm as an alternative method to prevent bleeding and recurrent infarction.
Keywords: Anterior cerebral artery, dissecting aneurysm, stent-assisted coil embolization
Spontaneous intracranial dissection is a major cause of hemorrhage or ischemic stroke.[
A 36-year-old man was admitted with sudden right hemiparesis. He had no abnormal history and had suffered no injury. On admission, diffusion-weighted magnetic resonance (MR) imaging showed cerebral infarction in the territory of the left ACA, and MR angiography revealed segmental stenosis at the A2 portion of the left ACA [
Transfemoral transarterial stent-assisted coil embolization of a dissecting aneurysm was performed under general anesthesia and heparinization. The left carotid artery was catheterized with a guiding catheter (Launcher, Medtronic, Inc., Minneapolis, MN, USA). Working angle for embolization was obtained using 3D rotational angiography [
(a) The digital subtraction angiogram in the operative view showed the aneurysm in the left A2 portion. (b) The cone-beam computed tomography revealed the stent covering the aneurysm neck and microcatheter inserted into the aneurysm. (c) The digital subtraction angiogram and (d) three-dimensional digital subtraction angiogram after stent-assisted embolization showed obliteration of the aneurysm and preservation of the left A2. (e) Follow-up three-dimensional digital subtraction angiogram performed 6 months after the operation showed moderate in-stent stenosis
The patient remained neurologically stable after the procedure and was discharged 5 days into admission. To this day, he continues to take two antiplatelet drugs (aspirin and clopidogrel) starting a week before the operation. Follow-up 3D-DSA performed 6 months after the operation showed moderate in-stent stenosis, but no neurological symptoms were observed a year after the operation [
Dissection in the ACA is rare compared to those found in the vertebrobasilar systems.[
There are few reported cases of ACA dissection where trapping and bypass surgery were attempted,[
Recently, several reports were written on fusiform aneurysms successfully treated using the flow diverter stent. Although this stent may be useful in future treatments for lesions in the internal carotid and vertebral arteries, its application for distal ACA dissection will remain technically difficult. Here, we considered stent-assisted coil embolization as an alternative treatment option for dissecting ACA aneurysms.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
We thank Yu Murano for excellent assistance with article revision.
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