A 28-year-old male without any previous medical history experienced right hemiplegia after a paroxysmal headache during sexual intercourse. He had a drowsy mentality and dysarthria. The National Institutes of Health Stroke Scale (NIHSS) score was 12. The brain magnetic resonance image (MRI) showed a pontine infarction (). The anterior-posterior view of his vertebral angiogram demonstrated an abrupt filling defect at the mid-basilar artery where the proximal margin of the defect was somewhat blurred and the distal was clearly circumscribed. On the lateral view, the abrupt filling defect was located at the anterior wall of the artery and the distal flow was compromised by a luminal stenosis (). These angiographic findings were highly suggestive of an anterior wall dissection of the basilar artery where the false lumen was filled up with mural hematoma.\nSince his neurological status had been deteriorating, a subsequent endovascular procedure was performed. After confirmation of the anatomical relationship between the true and false lumens, a microwire was navigated into the distal portion across the true lumen with extremely delicate handling to avoid incorrect cannulation into the false lumen. At the first trial of microwire navigation, it went into the intramural hematoma, and a clear resistance was noticed. Then, it was slightly pulled back and advanced again following the posterior wall of the diseased segment for a successful navigation. This maneuver confirmed presence of BAD. Then, a stent was deployed fully covering the lesion including some safety margins. After the stenting procedure, the distal flow was completely restored without residual false lumen (). A week later, he was able to walk unassisted. He discharged without any neurological deficits.
A 56-year-old male presented with deep stuporous consciousness with a Hunt and Hess grade of IV. Initial brain CT showed a thick SAH at the basal cistern, sylvian fissures, and anterior interhemispheric fissure (). Conventional cerebral angiography showed an azygous ACA, chronic total occlusion of the left proximal internal carotid artery (ICA), and a fusiform aneurysm on the right side wall of the A2 segment (). An arterial fenestration was also observed at the cavernous ICA. The aneurysm measured 6.25×2.86 mm in size on the 3-dimensional rotational angiogram with a neck size of 6.25 mm and height of 2.02 mm. The distal ACA flow remained patent without stenosis or occlusion.\nStent-assisted coil embolization of the azygous A2 dissecting aneurysm was performed under general anesthesia. A tiny remnant was left at the proximal portion (), however, follow-up angiography after two weeks showed complete obliteration of the aneurysm with preservation of the parent artery (). He showed improvement to drowsy mentality, but remained in a wheelchair-bound state.