Coil and Single-Stent Placement for Ruptured Dissecting Aneurysm of Middle Cerebral Artery: A Case Report

• Published in: World neurosurgery Vol. 113; pp. 208 - 211
• Main Authors: Ozaki, Tomohiko, Nishida, Takeo, Fujita, Yuya, Kishima, Haruhiko, Kinoshita, Manabu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2018
• Subjects: Dissecting aneurysm; Endovascular therapy; Middle cerebral artery; Dissecting aneurysm; CTA; Endovascular therapy; DSA; VBA; ICA; Middle cerebral artery; MCA; LSA; SAH
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.02.117

Ruptured dissecting aneurysms located at the middle cerebral artery (MCA) are rare, and their standard treatment has not been defined. Furthermore, lenticulostriate artery involvement in the dissecting segment makes treatment extremely difficult, and no previous reports have described successful treatment for such conditions. We herein report the case of a 74-year-old woman who presented with sudden severe headache from subarachnoid hemorrhage due to dissection in the proximal M1 segment of left MCA involving lenticulostriate arteries. Digital subtraction angiography on day 6 showed that the dissecting aneurysm had enlarged despite strict blood pressure control. On day 8, the patient was treated successfully with a self-expanding closed cell stent and coil embolization, preserving blood flow in the lenticulostriate arteries as well as the MCA. Follow-up digital subtraction angiography performed 5 weeks after endovascular therapy showed healing of the dissecting lesion, and the patient was discharged neurologically intact. •Ruptured dissecting aneurysms located at the MCA are rare and no standard of care has been defined.•Treatment strategy is extremely difficult for cases in which LSA are involved in the dissecting lesion.•LSA-involved ruptured MCA dissection was treated with a single-stent deployment and coil embolization.•This treatment option has been unreported for ruptured MCA dissection.