To report a rare case of internal carotid artery fenestration (ICAF) combined with contralateral internal carotid artery (ICA) dissection and to clarify its pathogenesis and guide individualized treatment through hemodynamic analysis.
Approach:
Case Presentation: A 71-year-old female with episodic dizziness underwent imaging that revealed bilateral ICA dissections and a right ICA fenestration, confirmed by digital subtraction angiography (DSA). Hemodynamic analysis was performed using computational fluid dynamics (CFD) to evaluate flow pressure, wall shear stress, and oscillatory shear index.
Key Findings:
The left ICA dissection was high-risk for rupture, while the right ICA fenestration was hemodynamically stable, as determined by CFD analysis.
The patient was treated with dual antiplatelet therapy followed by stent-assisted coiling of the left dissection, with imaging confirming complete resolution at follow-up.
Interpretation:
CFD hemodynamic analysis can help identify high-risk lesions and guide treatment decisions in patients with ICAF and contralateral dissection.
Limitations:
The study is based on a single case report, limiting generalizability and the ability to draw broader conclusions about treatment.
Conclusion:
Conservative management with antiplatelet therapy is appropriate for hemodynamically stable ICAF, as demonstrated in this case.
