Kanazawa R, Ishihara S, Okawara M, Ishihara H, Kohyama S, Yamane F
Division of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Saitama, Japan.
Minim Invasive Neurosurg. 2008 Oct;51(5):298-302. doi: 10.1055/s-0028-1082299. Epub 2008 Oct 14.
A 68-year-old male presented with a syncopal attack subsequent to acute myocardial infarction. His ultrasonographic and radiological examination revealed severe left internal carotid artery (ICA) stenosis and the presence of a persistent primitive hypoglossal artery (PPHA) immediately distal to the stenosis. The bilateral anterior and left middle cerebral arteries, and the vertebrobasilar system were opacified via the stenotic ICA. Carotid arterial stenting was selected as the treatment method because the lesion was high and a shunt placement during carotid endarterectomy was considered to be technically difficult. A self-expanding stent was successfully deployed with flow control, and the patient was discharged six days after surgery without any neurological deficit. There are sixteen reported cases including ours of PPHA associated with ICA stenosis presenting with ischemic attacks of the vertebrobasilar system. To the best of our knowledge, the current case is the first report of a cervical ICA stenosis with ipsilateral carotid-basilar anastomosis treated with carotid arterial stenting.
一名68岁男性在急性心肌梗死后出现晕厥发作。他的超声和放射学检查显示左侧颈内动脉（ICA）严重狭窄，且在狭窄远端紧邻处存在持续的原始舌下动脉（PPHA）。双侧大脑前动脉和左侧大脑中动脉以及椎基底系统通过狭窄的颈内动脉显影。由于病变位置较高且认为在颈动脉内膜切除术中放置分流器技术上困难，因此选择颈动脉支架置入术作为治疗方法。成功植入了自膨式支架并实现了血流控制，患者术后六天出院，无任何神经功能缺损。包括我们的病例在内，已有16例报告的PPHA与ICA狭窄相关并伴有椎基底系统缺血发作。据我们所知，本例是首例经颈动脉支架置入术治疗的伴有同侧颈动脉 - 基底吻合的颈内动脉狭窄病例。
