Acute thromboembolic complication after stent-assisted aneurysm embolization of ruptured dissecting aneurysm in communicating internal carotid artery segment

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Abstract Introduction: Dissecting aneurysms in the communicating segment of the internal carotid artery (ICA) is uncommon. Clinical evidence to support the use of endovascular treatment for dissecting aneurysms in the communicating segment of ICA has not been established. Patient concerns: A 48-year-old woman presented with complaints of sudden headaches with nausea and vomiting. Computed Tomography Head taken in another hospital showed subarachnoid hemorrhage. Diagnoses: Digital Subtraction Angiography examination of the head showed ruptured dissecting aneurysm in the communicating segment of ICA. Interventions: The patient underwent stent-assisted aneurysm embolization and acute thromboembolic complication occurred intra-operatively. Tirofiban was injected through the microcatheter and a Percutaneous Transluminal Angioplasty (PTA) balloon catheter was inserted in the stent. Following the treatment, a repeat digital subtraction angiography showed no aneurysm development and the right middle cerebral artery was unobstructed. The right ICA was observed for 30 minutes, and it remained patent. Outcomes: Seven hours after the procedure, the patient became drowsy, the right limb was paralyzed, and her speech was slurred. Magnetic resonance angiography and 3D time of flight showed severe stenosis of the right middle cerebral artery and anti-platelet drug was administered. At seven-month follow-up, the patient showed residual mild motor dysfunction of right hand and leg. Conclusion: For ruptured dissecting aneurysm in the communicating segment of ICA, endovascular treatment may be a suitable treatment. But there is a risk of acute thromboembolic complication during and after the procedure and hence requires careful monitoring.