Post-Operative ischaemic stroke as a sequelae of unnoticed small internal carotid artery intimal flap

Abstract

The risk of stroke associated with aneurysm coiling can occur as a result of thromboembolic complications. The iatrogenic internal carotid artery (ICA) dissection can also lead to ischemic stroke. A 42-year-old patient was diagnosed with a left ICA paraclinoid aneurysm. The endovascular coil embolisation was done. The aneurysm was completely obliterated with preservation of parent artery and distal flow. In the post-operative period, the patient developed a left middle cerebral artery territory infarct. The patient underwent decompressive hemicraniectomy and check data structures and algorithms (DSA) showed ICA dissection with no distal flow. The retrospective examination of earlier DSA revealed a suspected small intimal flap which later progressed to complete dissection and resulted in the infarct. We are reporting this case intending to emphasize careful examination of angiogram and findings suggestive of even a small intimal flap of ICA must not be overlooked. It might progress to frank dissection, stenosis of ICA and even fatal ischaemic stroke.