PMC4628206_01
Computed tomography angiography showing an intimal flap in the right internal carotid artery (ICA, arrow in A). Digital subtraction angiography showing a dissecting aneurysm with a double lumen (arrow in B) and extravasation of the contrast media at the ophthalmic segment of the right ICA (arrow in C). Postoperative angiography showing complete obliteration of the ICA with detachable coils (D).
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Emergent computed tomography (CT) demonstrated massive SAH mainly in the right basal cistern with an intracerebral hematoma, and CT angiography detected an intimal flap at the supraclinoid portion of the right ICA (Fig. 1A). Digital subtraction angiography (DSA) clearly detected a fusiform-shaped dissecting aneurysm at the ophthalmic segment of the ICA involving the posterior communicating artery (Fig. 1B, C). The patient underwent emergent endovascular trapping of the right ICA without bypass under general anesthesia (Fig. 1D).
Initial magnetic resonance (MR) angiography showing no abnormal findings on the left vertebral artery before the intervention (A), but segmental stenosis detected 1 week after endovascular trapping of the ICA (arrow in B and C). MR imaging showing an intramural hematoma on T1-weighted image (arrow in D). ICA: internal carotid artery.
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Systems, Munich, Germany). Surprisingly, follow-up MR imaging and DSA 7 days after the intervention showed segmental narrowing of the left VA with an intramural hematoma, which suggested that the intracranial VA dissection occurred postoperatively (Fig. 2).
Postoperative hemodynamic monitoring using PiCCO (Pulsion Medical Systems, Munich, Germany). Global end-diastolic volume index (A: GEDI; normal range, 680-800 ml/m2) and mean arterial pressure (B) as indicators of preload are high throughout the postoperative period. N.P: not performed.
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PiCCO monitoring clearly showed that global end-diastolic volume index (normal range, 680-800 ml/m2) and mean arterial pressure, indicators of preload, were high throughout the postoperative period (Fig. 3).