Abstract
We report a rare case of a ruptured dissecting aneurysm of the MCA treated using endovascular therapy in a 56-year-old woman with a subarachnoid hemorrhage. CT angiography on admission suggested right MCA dissection. DSA revealed an arterial wall irregularity accompanied by a blister-like aneurysm of the M1 segment of the MCA, and the patient was diagnosed with a ruptured dissecting aneurysm. Following conservative treatment using deep sedation and antihypertensive management, we performed single stent-assisted coil embolization on the 18th day of admission. Blood flow of the MCA and branch artery was maintained after embolization. Four weeks later, DSA revealed complete occlusion of the aneurysm and healing of the MCA dissection. The patient could walk after 3 months. DSA after 1 year showed no recurrence. A ruptured dissecting aneurysm of the MCA M1 segment invariably involves the lenticulostriate artery. Therefore, simple parent artery occlusion is ineffective as a therapeutic strategy. Few studies have reported successful surgical treatments that ensure the preservation of these arteries. Recent advances in endovascular treatment with stents have facilitated parent artery and branch preservation. Although the optimal timing of the acute phase treatment differs depending on the characteristics of each case, stent-assisted coil embolization is considered to be a promising option.
