Nishimura Shinjitsu, Nishino Akiko, Suzuki Shinsuke, Uenohara Hiroshi, Sakurai Yoshiharu, Suzuki Hiroyoshi
Department of Neurosurgery, Stroke Center, National Hospital Organization, Sendai Medical Center.
No To Shinkei. 2005 Sep;57(9):791-4.
We experienced the case of a dissecting carotid artery presenting with a pulsatile neck mass. This 60-year-old man was admitted to our department due to a progressive, painful left neck mass. The lesion was diagnosed as a dissecting left internal carotid artery with the subsequent formation of a giant pseudoaneurysm. First, the patient underwent an endovascular treatment using self-expandable stent and Guglielmi detachable coils (GDCs). However, four months after the treatment, recurrence of the pseudoaneurysm happened to him, and he was readmitted to our department. Angiographies revealed an enlargement of the pseudoaneurysm. Then, proximal occlusion of the left internal carotid artery was performed using a balloon and GDCs. Ten months after the second endovascular treatment, since symptoms of the central retinal artery embolism and progression of the mass effect occurred, surgical treatment with trapping and resection of the pseudoaneurysm was performed. We investigated pathologically the surgical specimen and could observe a partial thrombosed wall of the pseudoaneurysm. The multiple neovascular channels in the intima and media layers of the aneurysmal wall could be found, and the vasa vasorum in the adventitia was also noted. We thus suggest that mechanism of the enlargement of the pseudoaneurysm may be due to the retrograde neovascular supplies from the vasa vasorum. As a consequence, repeated bleeding and thrombosis in the dissecting arterial wall may result in the formation of partial thrombosed giant aneurysms.
我们遇到了一例伴有搏动性颈部肿块的颈动脉夹层病例。这位60岁男性因左侧颈部肿块进行性增大且疼痛而入住我科。该病变被诊断为左侧颈内动脉夹层并随后形成巨大假性动脉瘤。首先，患者接受了使用自膨式支架和 Guglielmi 可脱卸弹簧圈（GDC）的血管内治疗。然而，治疗四个月后，他的假性动脉瘤复发，再次入住我科。血管造影显示假性动脉瘤增大。然后，使用球囊和 GDC 对左侧颈内动脉进行近端闭塞。第二次血管内治疗十个月后，由于出现视网膜中央动脉栓塞症状和占位效应进展，遂进行了假性动脉瘤圈套切除的手术治疗。我们对手术标本进行了病理检查，观察到假性动脉瘤壁部分血栓形成。在动脉瘤壁的内膜和中膜层可发现多个新生血管通道，外膜中的滋养血管也被注意到。因此，我们认为假性动脉瘤增大的机制可能是由于滋养血管的逆行新生血管供应。结果，夹层动脉壁反复出血和血栓形成可能导致部分血栓形成的巨大动脉瘤的形成。
