Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection
Department of Radiology; Department of Neurosurgery
Nervous System Diseases | Neurology | Radiology | Surgery
Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4 days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6 months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up.
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Citation: J Neurointerv Surg. 2016 Apr;8(4):e13. doi: 10.1136/neurintsurg-2014-011596.rep. Epub 2015 Apr 8. Link to article on publisher's site
Aneurysm, Dissection, Intervention, Stent, Subarachnoid
Puri, Ajit S.; Gounis, Matthew J.; Massari, Francesco; Howk, Mary; Weaver, John P.; and Wakhloo, Ajay K., "Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection" (2016). Radiology Publications and Presentations. 172.