Patient with Recurrent Anterior Cerebral Artery Dissecting Aneurysm After Stent-Assisted Coil Embolization Successfully Treated with A3-A3 Anastomosis.

Background: With recent advances in endovascular devices and techniques, the use of endovascular treatment has been reported for intracranial dissecting aneurysms. However, the efficacy of this endovascular approach for intracranial dissection is still unknown. We report the case of a patient with a recurrent anterior cerebral artery (ACA) dissecting aneurysm after endovascular treatment.

Case Description: A 67-year-old woman underwent stent-assisted coil embolization for a ruptured ACA dissecting aneurysm of the left A2 segment. Aneurysmal dilatation was completely occluded after embolization. However, follow-up angiography 40 days after treatment showed compaction of the coil mass and reenlargement of the aneurysm. Open surgery was performed, considering the risk of rebleeding from the recurrent dissecting aneurysm. A3-A3 anastomosis followed by trapping of the coiled aneurysm along with the stent was successfully performed through the interhemispheric approach. The postoperative course was uneventful, and angiography 6 months after surgery revealed disappearance of the aneurysm and patency of the A3-A3 anastomosis.

Conclusions: Stent-assisted coil embolization for an ACA dissecting aneurysm may not be curative, and the coiled aneurysm may recur within a short time period. Microsurgical bypass trapping can be considered as the alterative or salvage treatment because of curability. Revascularization surgery, such as A3-A3 anastomosis, should be performed before trapping to avoid ischemic complications.