A Case of Ruptured Anterior Cerebral Artery Dissection Prevented from Re-rupture with Stenting and Modification of Antiplatelet Agents

Figures

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  Fig. 1. (A) Non-contrast head CT scan demonstrating diffuse subarachnoid hemorrhage predominantly in the left carotid cistern. (B) Three-dimensional CT scan showing an irregular dilatation in the left ACA across the A1-A2 segments (arrow). (C) Digital subtraction angiogram showing the recurrent artery of Heubner originating from the A1-A2 junction (arrow). (D) Digital subtraction angiogram showing enlargement of the A1 segment on postoperative day 8 (arrow). (E) In-stent stenting using LVIS Jr. 3.5 × 23 mm was performed. The proximal end of the stent showed insufficient expansion. (F) Postoperative three-dimensional rotational angiogram showing the enlarged portion (arrow). ACA: anterior cerebral artery, CT: computed tomography.

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  Fig. 2. (A, B) Digital subtraction angiograms on postoperative day 15 showing additional enlargement of the aneurysm. (C, D) Digital subtraction angiograms on postoperative day 22 showing thrombosis and shrinkage. (E, F) Digital subtraction angiogram on postoperative day 53 showing additional enlargement of the aneurysm. Contrast pooling in the aneurysm was observed. The microcatheter was navigated to the inflow of the aneurysm using the balloon catheter as a counter wall. Two coils were deployed into the aneurysm. (G) Digital subtraction angiograms on postoperative day 63 showing that the thrombosis of the bleb had progressed further, and the distal neck area was partially filled with contrast medium, but the tip of the bleb was not visualized. (H) Axial three-dimensional CT angiogram at 9 months after the final intervention showing thrombosis and shrinkage of the extra-stent component including the bleb (arrow). CT: computed tomography.

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  Fig. 3. Time course of aneurysm volume changes and antiplatelet drug dosage. Volume on the vertical axis relates to the non-thrombosed portion of the aneurysm. Volume measurement used thin slice data collected by CTA or rotational angiography processed on a workstation (Synapse Vincent; Fujifilm Medical, Tokyo, Japan). The volume was measured by tracing the contrast area outside the stent in the axial plane. CTA: computed tomography angiography.