Koyanagi Masaomi, Nishi Shogo, Hattori Itaro, Horikawa Fumihiko, Iwasaki Koichi
Department of Neurosurgery, Himeji Medical Center, Himeji, Hyogo, Japan.
Neurol Med Chir (Tokyo). 2004 Oct;44(10):544-7. doi: 10.2176/nmc.44.544.
A 57-year-old male presented with right amaurosis fugax and left transient ischemic attack caused by stenosis of the intracranial segment of the right internal carotid artery (ICA). Percutaneous transluminal angioplasty with stenting was successfully performed to dilate the stenosis. However, serial angiography revealed the development of a large pseudoaneurysm in the cervical ICA, probably as a result of carotid wall injury caused by the guiding catheter during the procedures. The patient underwent a second endovascular angioplasty. A Palmaz stent was placed across the aneurysm neck to stabilize the carotid wall. Guglielmi detachable coils were then inserted into the aneurysm cavity through the stent struts to successfully obliterate the aneurysm. Both the angiographical results and the patient's outcome were favorable. Stent-supported coil embolization is an effective and safe technique for medically refractory pseudoaneurysms, and may be a useful alternative to direct surgery.
一名57岁男性因右侧颈内动脉(ICA)颅内段狭窄出现右侧一过性黑矇和左侧短暂性脑缺血发作。成功进行了经皮腔内血管成形术加支架置入以扩张狭窄。然而,系列血管造影显示颈部ICA出现一个大的假性动脉瘤,可能是由于手术过程中引导导管导致颈动脉壁损伤所致。该患者接受了第二次血管腔内血管成形术。在动脉瘤颈部放置了一个Palmaz支架以稳定颈动脉壁。然后通过支架支柱将 Guglielmi 可脱性弹簧圈插入动脉瘤腔内,成功闭塞了动脉瘤。血管造影结果和患者预后均良好。支架辅助弹簧圈栓塞术是治疗药物难治性假性动脉瘤的一种有效且安全的技术,可能是直接手术的一种有用替代方法。