Simultaneous occurrence of subarachnoid hemorrhage and cerebral infarction caused by anterior cerebral artery dissection treated by endovascular trapping

Abstract

A 48-year-old man presented with a rare dissection of the anterior cerebral artery (ACA) causing simultaneous subarachnoid hemorrhage (SAH) and cerebral infarction manifesting as sudden onset of headache and left hemiparesis. Computed tomography and magnetic resonance imaging showed SAH localized in the interhemispheric fissure and cerebral infarction in the territory of the right ACA. Digital subtraction angiography (DSA) demonstrated segmental narrowing and dilatation at the right A1 and A2 portions of the ACA, leading to a diagnosis of ACA dissection. Fourteen days after the onset, DSA confirmed the enlarged fusiform dilatation of the right A2 portion with distal narrowing, suggesting the risk of rerupture of the dissection. Endovascular obliteration of the aneurysm with parent artery occlusion was performed without anastomosis on day 16. The aneurysm was catheterized and obliterated with detachable coils. Postoperative DSA revealed complete obliteration of the dissection and parent artery. The patient was doing well without recurrence of the dissection 8 months after the intervention. The simultaneous occurrence of SAH and cerebral infarction in patients with ACA dissection is extremely rare, and the optimal treatment has not yet been established. Endovascular treatment is safe and effective for the treatment of ACA dissection.