Intraarterial therapy for middle cerebral artery dissection with intramural hematoma detection on susceptibilityweighted imaging

Abstract

Background: Intracranial artery dissection (IAD) may be an underdiagnosed cause of large vessel occlusion. The safety and efficacy of intra-arterial therapy (IAT) in patients with IAD are largely unknown. We report the case of a patient with IAD who was successfully treated with IAT. Case Report: A 27-year-old man with a sudden-onset sensory dominant aphasia was admitted to our hospital around 16 hours after disease onset. Brain magnetic resonance angiography revealed an occlusion in the left distal middle cerebral artery (MCA). On the susceptibility-weighted imaging, bead-shaped dark signals were observed in the left MCA bifurcation, and intramural hematoma was suspected. We performed thrombectomy and permanent stenting for the dissecting MCA occlusion and achieved complete recanalization. Conclusion: The IMH on susceptibility-weighted imaging led us to suspect that the large vessel occlusion was due to the IAD. Further research is needed to address the efficacy and safety of IAT in patients with IAD.