PMC10446869_01
Computed tomography of the head showed diffuse subarachnoid hemorrhage (A). Digital subtraction angiography (B) and three-dimensional rotational angiography (C) showed a wall irregularity in the A1 segment of the right anterior cerebral artery.
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Computed tomography of the head showed Fisher group 3 subarachnoid hemorrhage (Fig. 1A). Digital subtraction angiography (DSA) and three-dimensional rotational angiography showed a vessel wall irregularity in the A1 segment of the right ACA, but an obvious bleeding source was not detected (Fig. 1B, C).
Digital subtraction angiography (right internal carotid artery injection) on day 5 (A), day 23 (B), and day 37 (C). Three-dimensional rotational angiography (maximum intensity projection sagittal view) on day 5 (D), day 23 (E), and day 37 (F). Both imaging modalities demonstrated vessel wall abnormalities and aneurysmal enlargement over time. An intimal flap (arrow) was visible on three-dimensional rotational angiography (maximum intensity projection coronal view) on day 5 (G). Three-dimensional rotational angiography on day 37 clearly showed enlargement of the aneurysm (3.5 x 3.5 x 3.5 mm) and a vessel wall irregularity in the A1 segment (H).
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A1 segment of the right ACA (Fig. 2A, D, G). A dissecting aneurysm of the right A1 segment was diagnosed. However, on day 23, angiography showed an increase in aneurysm size (2.2 x 2.1 x 2.0 mm) despite the improvement in vessel wall irregularity (Fig. 2B, E). Fourteen days later, angiography showed even more aneurysmal growth (Fig. 2C, F, H).
The Matas test showed sufficient collateral blood flow from the contralateral anterior cerebral artery (A). Bilateral internal carotid artery (ICA) angiography (B). No intraoperative aneurysmal rupture was observed during the internal trapping of the A1 segment (C). Bilateral ICA angiography after trapping showed complete obliteration of the dissected segment (D). Magnetic resonance imaging after trapping showed cerebral infarction in the territory of the A1 segment perforators (E).
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The Matas test was performed, which showed sufficient collateral blood flow from the contralateral ACA to the ipsilateral ACA territory (Fig. 3A). After the navigation of a microcatheter into the distal A1 segment, seven detachable coils were deployed to obliterate the dissected A1 segment (Fig. 3B, C). Postoperative bilateral internal carotid angiography showed complete obliteration of the dissected segment (Fig. 3D). Magnetic resonance imaging showed cerebral infarction in the territory of the perforating arteries of the A1 segment (Fig. 3E).