Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York 14209, USA.
J Neurointerv Surg. 2012 May;4(3):e6. doi: 10.1136/neurintsurg-2011-010026. Epub 2011 Jun 21.
Several case reports and studies suggest that partially thrombosed large and giant aneurysms are potential sources of distal embolic events. However, there are limited data on small thrombosed aneurysms as a possible cause of ischemic events. Three patients are reported who presented with acute ischemic stroke and in whom the initial imaging studies showed a small (<10 mm), unruptured, partially thrombosed aneurysm. In each case, the aneurysm location was confirmed by a conventional angiogram. In all cases, the aneurysms were found on the proximal middle cerebral artery, in the territory corresponding to the clinical symptoms of the stroke. The mechanism of middle cerebral artery embolic event was thought to be related to the thrombus within the aneurysm, causing subsequent embolization into distal related vascular territory. Two of these patients had craniotomy for aneurysm clipping; one was managed conservatively with medical therapy alone. Thrombosis of small, unruptured intracranial aneurysms should be considered as a possible cause of acute-onset stroke symptoms in patients with acute ischemic stroke. It is under-recognized in the current literature, and no guidelines currently exist for medical or surgical treatment of such aneurysms. Medical management is often decided on an individual basis. Surgical treatment mostly involves aneurysmal clipping rather than coiling.
一些病例报告和研究表明，部分血栓形成的大型和巨型动脉瘤是远端栓塞事件的潜在来源。然而，关于小血栓形成的动脉瘤作为缺血性事件的可能原因的数据有限。报告了 3 名患者，他们表现为急性缺血性中风，最初的影像学研究显示小(<10mm)、未破裂、部分血栓形成的动脉瘤。在每种情况下，动脉瘤的位置均通过常规血管造影术得到确认。在所有情况下，动脉瘤均位于大脑中动脉近端，与中风的临床症状相对应的区域。认为大脑中动脉栓塞事件的机制与动脉瘤内的血栓有关，导致随后向远端相关血管区域栓塞。其中 2 名患者接受了开颅夹闭术；1 名患者仅接受了单纯药物治疗。对于急性缺血性中风患者，小的、未破裂的颅内动脉瘤的血栓形成应被视为急性发作性中风症状的可能原因。目前文献对此认识不足，也没有针对此类动脉瘤的医疗或手术治疗指南。药物治疗通常是根据个人情况决定的。手术治疗主要涉及动脉瘤夹闭而不是线圈栓塞。
