Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection

Abstract

Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4 days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6 months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up.

MRI SPACE sequence confirmation of occluded MCA M2 dissection stump masquerading as a ruptured MCA aneurysm

“…Various treatment options were considered given prior reports of therapeutic success with intracranial stents 10. However, given the unpredictable natural history of cerebral dissection, revascularisation of this vessel was considered to possibly increase the risk of a recurrent haemorrhage event and the patient was scheduled for elective coil occlusion of the proximal aspect of the previously dissected/occluded MCA branch.…”