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Case Reports
. 2022;16(3):157-162.
doi: 10.5797/jnet.cr.2021-0054. Epub 2021 Aug 7.

Stent-Assisted Coil Embolization for Acute Ruptured Dissecting Aneurysm at the P2 Segment of the Posterior Cerebral Artery: A Case Report

Takashi Mitsuhashi  1 , Hidenori Oishi  2   3 , Kensaku Makino  1 , Joji Tokugawa  1 , Atsuhito Fuse  4 , Makoto Hishii  1
Affiliations
Case Reports

Stent-Assisted Coil Embolization for Acute Ruptured Dissecting Aneurysm at the P2 Segment of the Posterior Cerebral Artery: A Case Report

Takashi Mitsuhashi et al. J Neuroendovasc Ther. 2022.

Abstract

Objective: We report a case of ruptured posterior cerebral artery (PCA) dissecting aneurysm treated with stent-assisted coil embolization in the acute phase of ruptured aneurysm.

Case presentation: A 60-year-old woman presented with sudden onset of severe headache followed by unconsciousness. CT showed severe subarachnoid hemorrhage. Digital subtraction angiography showed a dissecting aneurysm at the P2 segment of the right PCA. Stent-assisted coil embolization was performed for the ruptured dissecting aneurysm. Since thrombus was observed in the stent, ozagrel was administered intravenously, and the thrombus gradually disappeared during the follow-up period. She was discharged without neurological deficit.

Conclusion: Parent artery occlusion is widely performed for acute ruptured PCA dissecting aneurysm, but reconstruction with stent-assisted coiling is considered to be an effective therapeutic strategy.

Keywords: dissecting aneurysm; posterior cerebral artery; stent-assisted coil embolization; subarachnoid hemorrhage.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1. Axial noncontrast cranial CT scan (A) showing diffuse thick SAH with intraventricular hemorrhage. Left vertebral angiograms, anteroposterior view (B), and lateral view (C) showing a dissecting aneurysm at the P2 segment of the right PCA. PCA: posterior cerebral artery; SAH: subarachnoid hemorrhage
Fig. 2
Fig. 2. 3D rotational angiogram of the working angle (A) showing two 2.5-mm aneurysms arising from both sides of the P2 segment of the right PCA. Left vertebral angiogram of the working angle (B) showing the dissecting aneurysm at the P2 segment of the right PCA. First, the Prowler Select Plus microcatheter was navigated into the distal portion of the right P2 (C and D). After the microcatheter was inserted into the dissecting aneurysm sac, an Enterprise stent was partially deployed from the distal end of the dissection to the proximal PCA. In addition, a microcatheter was placed in the other aneurysm sac, and then the Enterprise stent was fully deployed (E–G). Thrombus in the stent is recognized (H; arrowhead). PCA: posterior cerebral artery
Fig. 3
Fig. 3. Angiogram at 1 month after procedure, anteroposterior view (A), lateral view (B), and working angle (C) showing good obliteration of the dissecting aneurysm at the P2 segment of the right PCA. PCA: posterior cerebral artery
See this image and copyright information in PMC

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