The application of subintimal flap fenestration in iatrogenic carotid artery dissection - finding light through the darkness.

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.