title: The application of subintimal flap fenestration in iatrogenic carotid artery dissection - finding light through the darkness.
abstract: Acute iatrogenic flow-limiting dissection, a feared complication, developed in the tortuous cervical internal carotid artery (ICA) of a 35-year-old man during endovascular treatment of a growing left middle cerebral artery fusiform aneurysm. While attempting true lumen penetration, the guidewire perforated the dissection flap, regaining the true lumen. We fenestrated the intimal flap with a balloon and navigated a microcatheter through it in order to perform the intracranial embolization procedure. After aneurysm embolization, several stents were implanted for ICA restoration.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel. jcohenns@yahoo.com
authors.forename: J E
authors.initials: JE
authors.lastname: Cohen
authors.forename: J M
authors.initials: JM
authors.lastname: Gomori
authors.forename: E
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000209:etiology*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects; D017539:Tunica Intima; D014656:Vascular Surgical Procedures / Q000009:adverse effects