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.
We here report the methods for and efficacy of C-arm cone-beam CT (CBCT) with diluted contrast medium during the recanalization therapy in acute ischemic stroke patients with middle cerebral artery occlusion. Case Presentation: The subjects were 30 patients who underwent recanalization therapy for acute ischemic stroke with occlusion of the middle cerebral artery at our hospital between January 2015 and December 2016. Utilizing leptomeningeal anastomosis (LMA), 20-second CBCT with fourfold diluted contrast medium was performed, and 3D image processing was subsequently conducted. In 25 (83.3%) of the 30 patients, a blood vessel distal to the site of occlusion and the extent of thrombus were favorably visualized. Conclusion: This procedure may be useful as an auxiliary examination that provides more detailed information to safely perform recanalization therapy for acute occlusion of the middle cerebral artery through the visualization of a blood vessel distal to the site of the occlusion.
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