Subsequent rupture after clip on wrap method for ruptured dissecting aneurysm of the distal middle cerebral artery: a case report and review of the literature.

Dissecting aneurysms rarely occur in the middle cerebral artery (MCA). Furthermore, recurrent subarachnoid hemorrhage from ruptured dissecting aneurysms is rare with no published report of subsequent rupture after treatment by the clip on wrap method. The case reported is a 41-year-old man with subarachnoid hemorrhage. Angiography demonstrated aneurysm at the right M2 portion. We performed surgery to prevent rebleeding during the acute stage. Surgery revealed a discolored protrusion of the arterial wall of the lesion. The lesion was clipped on wrapping with Bemsheet. At one month postoperatively, angiography showed neither aneurysmal formation nor stenosis at the right M2, but after 5 months a subsequent rupture occurred. Angiography demonstrated pseudoaneurysm formation at the same portion of the right M2. The lesion was trapped with anastomosis of the superficial temporal artery (STA) to the MCA. He was discharged following a good recovery. The rate of subsequent rupture in ruptured dissecting aneurysm in the MCA is 14.3% in published papers. Acute surgery must be performed to prevent the risk of re-rupture. In our single case report, trapping was effective treatment.