Dados do Trabalho

Título

Cerebral ischemia due to spontaneous dissecting aneurysm of the anterior cerebral artery treated with a flow diverter stent Silk Vista Baby

RESUMO

Case presentation: A 68-year-old man admitted with sudden onset of weakness in his right leg, with no other neurological symptoms. He did not report headache. There were no illnesses in his medical history. Head computed tomography did not show ischemia or hemorrhage, while CT angiotomography revealed aneurysmal dilatation of left anterior cerebral artery (ACA), partially thrombosed. Subsequent cranial magnetic resonance imaging showed acute ischemia in the left ACA territory. Digital subtraction angiography confirmed aneurysmal dilatation in the A1-A2 transition of the left ACA measuring 10 x 7 x 6 mm, with a wide implantation base and the presence of a small stenosis in the post-aneurysmal segment, suggesting a dissecting etiology. Initially, he was treated with dual antiplatelet therapy. After 14 days of ictus, he underwent endovascular treatment with the flow diverter stent (FDS) Silk Vista Baby – SVB (Balt, Montmorency, France), without complications. Patient was discharged 2 days later with minimal right leg weakness, modified Rankin Scale 2.
Discussion: Spontaneous dissections of intracranial arteries are rare and there are few reports of spontaneous dissections of ACA, whose optimal treatment remains uncertain. Endovascular treatment of ACA dissection has been reported as a feasible alternative, especially in patients in whom subarachnoid hemorrhage is the main clinical presentation. However, in the reported cases of ACA dissection with ischemia alone, conservative treatment showed good outcome in most cases. FDS were initially designed and constructed for the treatment of aneurysms that could not be easily treated using more conventional endovascular approaches. The SVB is the first FDS that can be delivered via a 0.017 inch microcatheter and is designed to target aneurysms of the distal vasculature for which existing FDS are not optimized. By implanting the densely woven mesh in the parent vessel, the aneurysm neck is covered and blood flow is directed away from the aneurysm orifice. Despite the lack of studies, SVB has achieved sufficient occlusion rates of intracranial aneurysms originating from peripheral segments, which are comparable to conventional FDS with acceptably low complication rates.
Conclusion: Dissecting aneurysm is a rare cause of cerebral ischemia in the ACA territory and patients tend to have a good clinical outcome, as in the case presented. The SVB is a new promising device as a possible treatment.

Palavras Chave

dissecting aneurysm; intracranial artery dissection; Silk Vista Baby