title: Stent-assisted coil embolization for anterior cerebral artery dissection presented with cerebral infarction.
abstract: BACKGROUND
  Compared to those found in the vertebrobasilar system, intracranial dissection in the anterior circulation is relatively rare, especially in the anterior cerebral artery (ACA). Moreover, only several cases of ACA dissection that underwent endovascular treatment have been reported. Here we present a rare case of gradually developing ACA dissecting aneurysm causing cerebral infarction, successfully treated by stent-assisted coil embolization.
  
  
  METHODS
  A 36-year-old man was admitted with sudden right hemiparesis. Diffusion-weighted magnetic resonance (MR) imaging showed cerebral infarction in the left ACA territory, and MR angiography showed segmental stenosis at the A2 portion of the left ACA. Three-dimensional digital subtraction angiogram showed segmental dilatation and stenosis at the left A2 portion. We diagnosed ACA dissection causing acute cerebral infarction and treated the patient conservatively. Five months after the onset, the dissecting artery at the left A2 portion formed a gradually dilating aneurysm, suggesting increased risk for aneurysmal rupture. We attempted endovascular treatment entailing coil embolization of an aneurysm while preserving the left A2 with stent assistance. The patient remained neurologically stable 6 months after the procedure.
  
  
  CONCLUSIONS
  Although there are few reported cases of ACA dissection where endovascular treatment was attempted, we consider stent-assisted embolization for gradually developing ACA dissecting aneurysm as an alternative method to prevent bleeding and recurrent infarction.
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Itaro
authors.initials: I
authors.lastname: Hattori
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Hisatsugu
authors.initials: H
authors.lastname: Ishimori
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nemoto
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Chiyoe
authors.initials: C
authors.lastname: Hikita
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukuta
authors.affiliation: Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Morimoto
keywords: Anterior cerebral artery; dissecting aneurysm; stent-assisted coil embolization