PMC8571181_01
(a) Axial view of a head computed tomography revealed a left frontoparietal subarachnoid hemorrhage (black arrowhead) and a hyperdensity (white arrow) in the proximal segment (A1) of the left anterior cerebral artery. (b) Oblique view of a head computed tomography angiography with 3D reconstruction showed proximal stenosis (white arrowhead) and post stenotic dilation (white arrow) of the left A1 segment.
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ACA [Figure 1 and Panel-A]. A CT angiography (CTA) of the head showed proximal stenosis and post stenotic dilation of the left A1-segment [Figure 1 and Panel-B]. A cerebral digital subtraction angiography demonstrated an IDA of the left A1-segment [Figure 2].
Diagnostic cerebral digital subtraction angiography. Anteroposterior (a) and lateral (b) views of a left common carotid artery contrast injection confirmed a ruptured intracranial dissecting aneurysm (white arrow) of the left A1 segment.
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A CT angiography (CTA) of the head showed proximal stenosis and post stenotic dilation of the left A1-segment [Figure 1 and Panel-B]. A cerebral digital subtraction angiography demonstrated an IDA of the left A1-segment [Figure 2].
Digital subtraction angiography anteroposterior projection. Road mapping microcatheterization until A3-segment (a) and PPD implantation from A2 to A1 was performed. Immediate post procedural cerebral digital subtraction angiography. Anteroposterior (b) and oblique (c) views of a left internal carotid artery contrast injection after deployment of the Pipeline shield in the left A1 segment (white arrow).
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PhenomTM 027 microcatheter (Medtronic Inc., Irvine, California, USA) in Avigo  Hydrophilic Guidewire (Medtronic Inc., Irvine, California, USA) A Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield; Medtronic Inc., Irvine, California, USA) was strategically deployed, from the A2-segment to A1-segment of the left ACA. Post procedure angiography showed adequate permeability of the FDD [Figure 3].
On post procedural examination, there was evidence of mild left-eye ptosis (a), a non-reactive dilated left pupil (b), left superior (c), medial (d), inferior recti (e), and inferior oblique muscles paresis consistent with an incomplete third cranial nerve palsy.
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On examination, there was evidence of preserved visual acuity for both eyes; mild left-eye ptosis; a non-reactive dilated left pupil; left superior, medial, inferior recti, and inferior oblique muscle paresis [Figure 4].
One-month follow-up cerebral digital subtraction angiography. Anteroposterior (a) and lateral (b) views of a left common carotid artery contrast injection confirmed the complete exclusion of the left A1 dissecting aneurysm (white arrow).
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On the 1-month follow-up angiography, there was complete exclusion of the IDA [Figure 5].