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 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 ().