Sámano Abenamar, Ishikawa Tatsuya, Moroi Junta, Yamashita Shingo, Suzuki Akifumi, Yasui Nobuyuki
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels Akita, Akita City, Japan.
Surg Neurol Int. 2011 Mar 23;2:35. doi: 10.4103/2152-7806.78243.
Several de novo intracranial aneurysms have been described related to changes in hemodynamics after therapeutic occlusion of internal carotid artery (ICA); however, de novo aneurysms related to a supraclinoid arteriosclerotic stenosis of the ICA have not been described yet. Authors consider that it is important to bear in mind the possibility of developing an aneurysm in these special conditions.
The evolution of a 62-year-old patient with subarachnoid hemorrhage, intraparenchymal frontal hematoma with some atypical circumstances that were presented together as well as the treatment he received are shown in this report. We can see this patient suffered a right thalamic hemorrhage at the age of 51 years; this condition was associated to a severe atherosclerotic stenosis of right supraclinoid ICAy. A long term had elapsed since the diagnosis of the stenosis and the discovery of a ruptured ipsilateral de novo supraclinoid internal carotid artery-posterior communicating artery (ICA-PcomA) aneurysm.
IT SEEMS LIKE BOTH CONDITIONS: the atherosclerotic supraclinoid ICA which tells of an Samano et at: Ruptured De Novo PcomA Aneurysm Associated with Arteriosclerotic Stenosis of Supraclinoid ICA. Altered vessel environment coupled to a long exposure time, hemodynamic changes, unbalance in the wall sheer stress could all of them lead to the development of the de novo aneurysm.
已有数例关于颈内动脉（ICA）治疗性闭塞后血流动力学改变相关的新发颅内动脉瘤的报道；然而，与ICA鞍上动脉硬化性狭窄相关的新发动脉瘤尚未见报道。作者认为，在这些特殊情况下应牢记发生动脉瘤的可能性。
本报告展示了一名62岁蛛网膜下腔出血患者的病情演变，同时还伴有一些非典型情况的脑实质内额叶血肿以及他所接受的治疗。我们可以看到，该患者51岁时发生了右侧丘脑出血；这种情况与右侧鞍上ICA严重动脉硬化性狭窄有关。自狭窄诊断至同侧新发鞍上颈内动脉 - 后交通动脉（ICA - PcomA）动脉瘤破裂发现，已过去很长时间。
似乎以下两种情况：即提示存在萨马诺等人所述的鞍上ICA动脉硬化，血管环境改变加上长时间暴露、血流动力学变化、壁面切应力失衡，所有这些都可能导致新发动脉瘤的形成。
