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The application of subintimal flap fenestration in iatrogenic carotid artery dissection - finding light through the
J E Cohen1, J M Gomori, E Itshayek
1Department of Neurosurgery, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel. jcohenns@yahoo.com
Abstract:
Acute iatrogenic flow-limiting dissection, a feared complication, developed in the tortuous cervical internal carotid artery (ICA) of a 35-year-old man during endovascular treatment of a growing left middle cerebral artery fusiform aneurysm. While attempting true lumen penetration, the guidewire perforated the dissection flap, regaining the true lumen. We fenestrated the intimal flap with a balloon and navigated a microcatheter through it in order to perform the intracranial embolization procedure. After aneurysm embolization, several stents were implanted for ICA restoration.