{"title":"Microsurgery for anterior communicating artery aneurysms: One size does not fit all","authors":"Adesh Shrivastava, S. Nair, Rakesh Mishra","doi":"10.4103/jcvs.jcvs_22_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_22_22","url":null,"abstract":"","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126801708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The surgical complications in aneurysmal microsurgical clipping are attributable primarily to vascular compromise and retraction injury. The vascular complications almost 50% of these. ICG-VA gives us intraoperative real-time high definition functional imaging of the cerebrovascular tree, thereby allowing immediate quality assessment and control of aneurysm obliteration and parent vessel optimisation. Here we report our preliminary data of an ongoing series of patient study. Objective: This study aims at evaluating the role of ICG VA in avoiding vascular complications during microsurgical clipping of ruptured intracranial aneurysms and ascertaining normative data for ICG dye administration. Materials and Methods: The study aimed at determining the utility of microscope incorporated (Leica M530 OHX microscope) ICG VA in ruptured aneurysm surgery. We used ICG-VA in 17 patients of ruptured aneurysm with WFNS grade 1 and 2 as an adjunct to surgery. We studied multiple patient characteristics, intraoperative ICG peak flow and washout time of dye, and changes made in the operative decisions, and outcome of the surgeries. Results: ICG-VA helped in intraoperative decision making for 5 out of 17 patients. In one patient, inadequate clipping with residual neck was confirmed with ICG-VA and the clip was adjusted. In three patient's perforator/additional vessel compromise was found hence needed clip readjustment, whereas in two patients ICG-VA demonstrated residual filling of large neck sac and 2nd clip was applied in tandem. Conclusion: ICG VA is a conclusively simple adjunctive tool for the early detection and prevention of vascular compromise of multiple vessels and perforators during ruptured aneurysm surgery.
{"title":"Indocyanine green fluorescence video angiography – An indispensable tool for avoiding vascular complications during microsurgical clipping of ruptured intracranial aneurysms and improving surgical outcome: A preliminary study","authors":"A. Acharya, Sarvpreet Singh Grewal","doi":"10.4103/jcvs.jcvs_14_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_14_22","url":null,"abstract":"Background: The surgical complications in aneurysmal microsurgical clipping are attributable primarily to vascular compromise and retraction injury. The vascular complications almost 50% of these. ICG-VA gives us intraoperative real-time high definition functional imaging of the cerebrovascular tree, thereby allowing immediate quality assessment and control of aneurysm obliteration and parent vessel optimisation. Here we report our preliminary data of an ongoing series of patient study. Objective: This study aims at evaluating the role of ICG VA in avoiding vascular complications during microsurgical clipping of ruptured intracranial aneurysms and ascertaining normative data for ICG dye administration. Materials and Methods: The study aimed at determining the utility of microscope incorporated (Leica M530 OHX microscope) ICG VA in ruptured aneurysm surgery. We used ICG-VA in 17 patients of ruptured aneurysm with WFNS grade 1 and 2 as an adjunct to surgery. We studied multiple patient characteristics, intraoperative ICG peak flow and washout time of dye, and changes made in the operative decisions, and outcome of the surgeries. Results: ICG-VA helped in intraoperative decision making for 5 out of 17 patients. In one patient, inadequate clipping with residual neck was confirmed with ICG-VA and the clip was adjusted. In three patient's perforator/additional vessel compromise was found hence needed clip readjustment, whereas in two patients ICG-VA demonstrated residual filling of large neck sac and 2nd clip was applied in tandem. Conclusion: ICG VA is a conclusively simple adjunctive tool for the early detection and prevention of vascular compromise of multiple vessels and perforators during ruptured aneurysm surgery.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116480016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mahajan, Daljit Singh, H. Sahni, Sumit Bhandari, D. Vishwakarma
The study design was a case report of spinal cord arteriovenous malformation (SCAVM) with various associations. The objective of this study was to demonstrate the need to identify atypical clinical associations with spinal arteriovenous malformation and their staged management. A 19-year-old boy was diagnosed with SCAVM after paraplegia and bowel bladder disturbances. However, a complete diagnosis of SCAVM with its syndromic association helps to treat the patient in holistic way. The correct diagnosis of SCAVMs and their type is difficult. Complete diagnosis relies on radiological investigations as well as detailed examination. The early and complete diagnoses of SCAVMs are important because patients are likely to have better functional statuses after treatment if their pre-treatment deficits are relatively mild.
{"title":"Syndromic association of spinal arteriovenous malformations: CLOVES syndrome","authors":"M. Mahajan, Daljit Singh, H. Sahni, Sumit Bhandari, D. Vishwakarma","doi":"10.4103/jcvs.jcvs_21_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_21_22","url":null,"abstract":"The study design was a case report of spinal cord arteriovenous malformation (SCAVM) with various associations. The objective of this study was to demonstrate the need to identify atypical clinical associations with spinal arteriovenous malformation and their staged management. A 19-year-old boy was diagnosed with SCAVM after paraplegia and bowel bladder disturbances. However, a complete diagnosis of SCAVM with its syndromic association helps to treat the patient in holistic way. The correct diagnosis of SCAVMs and their type is difficult. Complete diagnosis relies on radiological investigations as well as detailed examination. The early and complete diagnoses of SCAVMs are important because patients are likely to have better functional statuses after treatment if their pre-treatment deficits are relatively mild.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125194201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roopesh Kumar, A. Karthikayan, Adhithyan Rajendran
Optochiasmatic hypothalamic cavernous malformations (CMs) are exceedingly rare lesions and can manifest with visual deficits of varying magnitudes. They also can result in sudden-onset visual loss due to apoplexy. Magnetic resonance imaging can delineate the lesions and differentiate it from other common lesions like glioma or craniopharyngioma. Preoperative visual assessment including perimetry and optical coherence tomogram has to be performed whenever possible to assess the degree of deficits and also for prognostication. Microsurgical excision improves the visual deficits in majority of instances as documented by earlier reports and has to be undertaken as an emergency in apoplexy. Various corridors can be used to reach the lesion including anterolateral, midline transbasal anterior interhemispheric approach, and transnasal endoscopic approaches. The aim should be to achieve a gross total excision with minimal manipulation of surrounding white matter tracts to improve the visual outcome. There is a limited role for stereotactic radiosurgery. In the present study, we report three cases of CMs involving optic chiasm and hypothalamus including a case of apoplexy managed by gross total microsurgical resection with good outcome and also review the relevant literature on the natural history and management strategies
{"title":"Optico-chiasmatic hypothalamic cavernomas - A report of three cases and review of literature","authors":"Roopesh Kumar, A. Karthikayan, Adhithyan Rajendran","doi":"10.4103/jcvs.jcvs_8_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_8_22","url":null,"abstract":"Optochiasmatic hypothalamic cavernous malformations (CMs) are exceedingly rare lesions and can manifest with visual deficits of varying magnitudes. They also can result in sudden-onset visual loss due to apoplexy. Magnetic resonance imaging can delineate the lesions and differentiate it from other common lesions like glioma or craniopharyngioma. Preoperative visual assessment including perimetry and optical coherence tomogram has to be performed whenever possible to assess the degree of deficits and also for prognostication. Microsurgical excision improves the visual deficits in majority of instances as documented by earlier reports and has to be undertaken as an emergency in apoplexy. Various corridors can be used to reach the lesion including anterolateral, midline transbasal anterior interhemispheric approach, and transnasal endoscopic approaches. The aim should be to achieve a gross total excision with minimal manipulation of surrounding white matter tracts to improve the visual outcome. There is a limited role for stereotactic radiosurgery. In the present study, we report three cases of CMs involving optic chiasm and hypothalamus including a case of apoplexy managed by gross total microsurgical resection with good outcome and also review the relevant literature on the natural history and management strategies","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130934944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Microsurgery of complex intracranial aneurysms","authors":"B. Misra, Harshad R Purandare","doi":"10.4103/jcvs.jcvs_6_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_6_22","url":null,"abstract":"","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"277 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133571797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. N. Kumar, R. Prasad, Senthil Kumar, A. Pravallika
Anterior communicating (ACOM) aneurysms are the most common intracranial aneurysms. About 30%–40% of ruptured intracranial aneurysms are ACOM aneurysms. Its complex structural and anatomical variability and its critical location pose a great challenge to the surgeon during microsurgical clipping. We share our experience in clipping these aneurysms and its outcome. The aim was to study the outcome following microsurgical clipping of ACOM artery aneurysm presenting with rupture and subarachnoid haemorrhage and to determine the factors which dictate the clinical outcome after 6 months. The study includes all cases of ruptured ACOM aneurysms who underwent microsurgical clipping between the period of 2016 and 2020. The medical records were analysed retrospectively and results were recorded. The study shows that the outcome of the patients depends on presenting World Federation of Neurological Surgeons grade, anterosuperiorly projecting aneurysms are at high risk for intraoperative rupture and complications such as lacunar infarcts are common with the usage of temporary clips.
{"title":"Outcome of microsurgical clipping of anterior communicating aneurysms: A single-centre experience","authors":"M. N. Kumar, R. Prasad, Senthil Kumar, A. Pravallika","doi":"10.4103/jcvs.jcvs_10_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_10_22","url":null,"abstract":"Anterior communicating (ACOM) aneurysms are the most common intracranial aneurysms. About 30%–40% of ruptured intracranial aneurysms are ACOM aneurysms. Its complex structural and anatomical variability and its critical location pose a great challenge to the surgeon during microsurgical clipping. We share our experience in clipping these aneurysms and its outcome. The aim was to study the outcome following microsurgical clipping of ACOM artery aneurysm presenting with rupture and subarachnoid haemorrhage and to determine the factors which dictate the clinical outcome after 6 months. The study includes all cases of ruptured ACOM aneurysms who underwent microsurgical clipping between the period of 2016 and 2020. The medical records were analysed retrospectively and results were recorded. The study shows that the outcome of the patients depends on presenting World Federation of Neurological Surgeons grade, anterosuperiorly projecting aneurysms are at high risk for intraoperative rupture and complications such as lacunar infarcts are common with the usage of temporary clips.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"29 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133775158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Navneet Singla, K. Reddy, A. Aggarwal, R. Chhabra, H. Bhagat
Introduction: For a disease like aneurysmal subarachnoid haemorrhage (aSAH) which continues to have high morbidity and mortality, prognostication is imperative. This gives realistic goals to both the health-care worker and the patient. Unfavourable brain conditions during surgery like dural bulge, brain swelling, petechial haemorrhages, need for ventricular tap are conventionally thought to be harbingers of poor outcomes. But is it really so? Methods: Fifty-four consecutively operated patients of aSAH were studied. Clinical grade at admission (H and H, World Federation of Neurosurgical Societies (WFNS)), Dural bulge, brain swelling, petechial haemorrhages, need for ventricular tap, and brain pulsatility were studied for outcome parameters like Glasgow outcome scale (GOS) at 1 and 3 months and development of focal deficits. Results: H and H and WFNS grades had a significant correlation with GOS. We found that the need for augmentation duraplasty had a significant association with the outcome and appearance of focal deficits. However, unfavourable brain conditions like--dural bulge, brain swelling, petechial haemorrhages, need for ventricular tap, absence of brain pulsatility during surgery did not have a significant impact on the outcome. Conclusions: Clinical grading by far remains the best predictor of outcome. Intra-operative brain conditions did not have a bearing on the outcome. The mechanism by which poor grade patients exhibit poor outcomes remains elusive. At least in the present study, it was not by way of manifesting as unfavourable brain conditions. A word of caution--further large studies are required before definite conclusions can be drawn.
{"title":"Do intra operative brain conditions during clipping for ruptured intra cranial aneurysms affect the outcome? Being devil's advocate","authors":"Navneet Singla, K. Reddy, A. Aggarwal, R. Chhabra, H. Bhagat","doi":"10.4103/jcvs.jcvs_11_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_11_22","url":null,"abstract":"Introduction: For a disease like aneurysmal subarachnoid haemorrhage (aSAH) which continues to have high morbidity and mortality, prognostication is imperative. This gives realistic goals to both the health-care worker and the patient. Unfavourable brain conditions during surgery like dural bulge, brain swelling, petechial haemorrhages, need for ventricular tap are conventionally thought to be harbingers of poor outcomes. But is it really so? Methods: Fifty-four consecutively operated patients of aSAH were studied. Clinical grade at admission (H and H, World Federation of Neurosurgical Societies (WFNS)), Dural bulge, brain swelling, petechial haemorrhages, need for ventricular tap, and brain pulsatility were studied for outcome parameters like Glasgow outcome scale (GOS) at 1 and 3 months and development of focal deficits. Results: H and H and WFNS grades had a significant correlation with GOS. We found that the need for augmentation duraplasty had a significant association with the outcome and appearance of focal deficits. However, unfavourable brain conditions like--dural bulge, brain swelling, petechial haemorrhages, need for ventricular tap, absence of brain pulsatility during surgery did not have a significant impact on the outcome. Conclusions: Clinical grading by far remains the best predictor of outcome. Intra-operative brain conditions did not have a bearing on the outcome. The mechanism by which poor grade patients exhibit poor outcomes remains elusive. At least in the present study, it was not by way of manifesting as unfavourable brain conditions. A word of caution--further large studies are required before definite conclusions can be drawn.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114890371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: R is a programming language that can be used to efficiently solve statistical problems. Objectives: To demonstrate the method of building functions using R in statistical analysis and storing it for future use. Materials and Methods: A real world example of comparison of statistical values in aneurysm research with respect to its locations has been used to demonstrate how one might build a function using R. Results: Accurate results could be obtained and the function can be stored for later use. Conclusions: As the statistical tools required in research are recurrent, building functions in R and storing them for future use is highly recommended.
{"title":"Statistical corner: Building own functions in R","authors":"Mikko J. Pyysalo","doi":"10.4103/jcvs.jcvs_22_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_22_21","url":null,"abstract":"Introduction: R is a programming language that can be used to efficiently solve statistical problems. Objectives: To demonstrate the method of building functions using R in statistical analysis and storing it for future use. Materials and Methods: A real world example of comparison of statistical values in aneurysm research with respect to its locations has been used to demonstrate how one might build a function using R. Results: Accurate results could be obtained and the function can be stored for later use. Conclusions: As the statistical tools required in research are recurrent, building functions in R and storing them for future use is highly recommended.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132985363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madhavi Karri, Balakrishnan Ramasamy, E. Swamiappan, S. Perumal, K. Kannan
Takayasu's arteritis (TA) is chronic inflammatory vasculopathy preferentially affecting the aorta and its major branches. It is one of the potential causes of stroke in young adults. Here, we report a young female who presented to us with an acute-onset right hemiparesis with motor aphasia after 10 h of symptoms onset. Her National Institute of Health Stroke Scale (NIHSS) score at admission was 12. The stroke imaging showed acute infarct in the left middle cerebral artery territory with arterial spin labelling perfusion sequence showing diffusion perfusion mismatch with good penumbra. She underwent intravenous thrombolysis with tenecteplase, based on imaging findings and despite being out of window period. She had an excellent clinical recovery and was discharged with oral anticoagulant and azathioprine. After 3 months of stroke and recovery, follow-up was unremarkable with minimal residual deficits with an NIHSS score of 4 and Modified Rankin Scale of 1. Hence, appropriate early interventions in acute stroke in TA individuals are highly beneficial and timely considered for a good outcome and better quality of life.
{"title":"Thrombolysis beyond the time window in takayasu's arteritis: A challenging experience","authors":"Madhavi Karri, Balakrishnan Ramasamy, E. Swamiappan, S. Perumal, K. Kannan","doi":"10.4103/jcvs.jcvs_20_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_20_21","url":null,"abstract":"Takayasu's arteritis (TA) is chronic inflammatory vasculopathy preferentially affecting the aorta and its major branches. It is one of the potential causes of stroke in young adults. Here, we report a young female who presented to us with an acute-onset right hemiparesis with motor aphasia after 10 h of symptoms onset. Her National Institute of Health Stroke Scale (NIHSS) score at admission was 12. The stroke imaging showed acute infarct in the left middle cerebral artery territory with arterial spin labelling perfusion sequence showing diffusion perfusion mismatch with good penumbra. She underwent intravenous thrombolysis with tenecteplase, based on imaging findings and despite being out of window period. She had an excellent clinical recovery and was discharged with oral anticoagulant and azathioprine. After 3 months of stroke and recovery, follow-up was unremarkable with minimal residual deficits with an NIHSS score of 4 and Modified Rankin Scale of 1. Hence, appropriate early interventions in acute stroke in TA individuals are highly beneficial and timely considered for a good outcome and better quality of life.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124378964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amit Sharma, A. Jagetia, A. Srivastava, Daljit Singh
The risk of stroke associated with aneurysm coiling can occur as a result of thromboembolic complications. The iatrogenic internal carotid artery (ICA) dissection can also lead to ischemic stroke. A 42-year-old patient was diagnosed with a left ICA paraclinoid aneurysm. The endovascular coil embolisation was done. The aneurysm was completely obliterated with preservation of parent artery and distal flow. In the post-operative period, the patient developed a left middle cerebral artery territory infarct. The patient underwent decompressive hemicraniectomy and check data structures and algorithms (DSA) showed ICA dissection with no distal flow. The retrospective examination of earlier DSA revealed a suspected small intimal flap which later progressed to complete dissection and resulted in the infarct. We are reporting this case intending to emphasize careful examination of angiogram and findings suggestive of even a small intimal flap of ICA must not be overlooked. It might progress to frank dissection, stenosis of ICA and even fatal ischaemic stroke.
{"title":"Post-Operative ischaemic stroke as a sequelae of unnoticed small internal carotid artery intimal flap","authors":"Amit Sharma, A. Jagetia, A. Srivastava, Daljit Singh","doi":"10.4103/jcvs.jcvs_5_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_5_22","url":null,"abstract":"The risk of stroke associated with aneurysm coiling can occur as a result of thromboembolic complications. The iatrogenic internal carotid artery (ICA) dissection can also lead to ischemic stroke. A 42-year-old patient was diagnosed with a left ICA paraclinoid aneurysm. The endovascular coil embolisation was done. The aneurysm was completely obliterated with preservation of parent artery and distal flow. In the post-operative period, the patient developed a left middle cerebral artery territory infarct. The patient underwent decompressive hemicraniectomy and check data structures and algorithms (DSA) showed ICA dissection with no distal flow. The retrospective examination of earlier DSA revealed a suspected small intimal flap which later progressed to complete dissection and resulted in the infarct. We are reporting this case intending to emphasize careful examination of angiogram and findings suggestive of even a small intimal flap of ICA must not be overlooked. It might progress to frank dissection, stenosis of ICA and even fatal ischaemic stroke.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115239131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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