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.
A 48-year-old female presented with a sudden bursting headache and right hemiparesis of grade I/V. Initial brain computed tomography (CT) showed an obvious SAH at the anterior interhemispheric fissure and left superior frontal sulcus (). Conventional cerebral angiography showed abrupt luminal tapering of the left distal ACA with compromised distal flow (). Her brain magnetic resonance imaging (MRI) showed an acute cerebral infarction in the left ACA vascular territory ().\nConservative treatment was administered since the area of infarction matched the presumed territory of the occluded ACA without penumbra zone and further revascularization might not guarantee any benefit. Three months later, she was able to walk unassisted with minor motor weakness of grade IV/V on her right leg. She underwent repeated follow-up cerebral angiographies which showed remarkable arterial healing. Follow-up angiography after 33 months showed complete luminal healing without aneurysmal formation ().