Fuse T, Niwa Y, Harada S
Department of Neurosurgery, National Tohsei Hospital, Shizuoka.
Neurol Med Chir (Tokyo). 2000 Dec;40(12):641-4. doi: 10.2176/nmc.40.641.
Two cases of embolic stroke associated with vascular anomalies were treated by intraarterial fibrinolytic therapy. A 78-year-old male had embolic stroke associated with fenestration of the middle cerebral artery (MCA). The embolus lodged in the terminal portion of the right internal carotid artery (ICA) and in the M2 portion of the right MCA. The fenestration was not detected before local fibrinolytic therapy, but was identified by postinterventional angiography. An 82-year-old female had a left-sided persistent primitive trigeminal artery (PPTA), and the embolus lodged in the terminal portion of the left ICA. Left internal carotid angiography also showed rich collateral circulation via the abundant leptomeningeal anastomosis. The PPTA involved the left ICA, so the anomalous anatomy had to be considered in performing local thrombolysis. However, the rich collateral circulation allowed recanalization of the occluded ICA without inducing bleeding. Dissolution of persistently adherent emboli must be performed with great care because of the possibility of such rare vascular anomalies.
两例与血管异常相关的栓塞性中风患者接受了动脉内溶栓治疗。一名78岁男性患有与大脑中动脉（MCA）开窗相关的栓塞性中风。栓子位于右侧颈内动脉（ICA）末端和右侧MCA的M2段。在局部溶栓治疗前未检测到开窗，但在介入后血管造影中得以识别。一名82岁女性有左侧永存原始三叉动脉（PPTA），栓子位于左侧ICA末端。左侧颈内动脉血管造影还显示通过丰富的软脑膜吻合形成了丰富的侧支循环。PPTA累及左侧ICA，因此在进行局部溶栓时必须考虑这种异常解剖结构。然而，丰富的侧支循环使得闭塞的ICA得以再通而未引起出血。由于存在这种罕见血管异常的可能性，对于持续附着的栓子进行溶解时必须格外小心。
