Gao Peng, Gui Liqiang, Yang Bin, Krings Timo, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2018 Oct 16;9:858. doi: 10.3389/fneur.2018.00858. eCollection 2018.
The diagnosis of intracranial arterial dissection (IAD) may be challenging and multimodal imaging techniques are often needed to confirm the diagnosis. Previous studies have based their criteria for diagnosis of IAD on conventional angiography, computed tomography, or magnetic resonance imaging. We report a case with acute ischemic stroke due to spontaneous basilar artery dissection in which intravascular optical coherence tomography (OCT) was used to show features of IAD. A 59-years-old woman presented with symptoms of acute ischemic stroke. Thrombosis related to basilar artery (BA) stenosis was assumed on conventional angiography; however, no clot was retrieved after mechanical thrombectomy (MT) and a restored BA caliber was observed after a rescue recanalization with the detachment of a self-expanding stent was performed. Spontaneous IAD was suspected; however, angiographic findings were ambiguous for confirming IAD. The patient remained symptom-free until 18-months follow-up. At this point, angiography showed restenosis at the proximal tapered length of the stent. OCT was performed to assess the pathological changes of the restenosis and confirm the diagnosis of IAD.OCT revealed BA dissection with the presence of remnant transverse flap, double lumen and mural hematoma. Imaging at multiple levels identified intimal disruption that originated in the right vertebral artery and extended distally to the BA. The use of intravascular imaging with OCT enabled the accurate diagnosis of IAD. Care should be taken as the procedure may add additional risks to the patient. Future studies are needed to validate the safety of OCT in IAD.
颅内动脉夹层（IAD）的诊断可能具有挑战性，通常需要多模态成像技术来确诊。以往的研究基于传统血管造影、计算机断层扫描或磁共振成像制定IAD的诊断标准。我们报告一例因自发性基底动脉夹层导致急性缺血性卒中的病例，其中使用血管内光学相干断层扫描（OCT）显示了IAD的特征。一名59岁女性出现急性缺血性卒中症状。传统血管造影显示与基底动脉（BA）狭窄相关的血栓形成；然而，机械取栓（MT）后未取出血栓，在进行自膨式支架取出的补救再通术后观察到BA管径恢复。怀疑为自发性IAD；然而，血管造影结果对于确诊IAD并不明确。该患者在18个月的随访期内一直无症状。此时，血管造影显示支架近端逐渐变细处出现再狭窄。进行OCT以评估再狭窄的病理变化并确诊IAD。OCT显示BA夹层，存在残余横向瓣片、双腔和壁内血肿。多层成像确定内膜破裂起源于右侧椎动脉并向远端延伸至BA。使用OCT进行血管内成像能够准确诊断IAD。操作时应谨慎，因为该操作可能给患者增加额外风险。需要进一步研究来验证OCT在IAD中的安全性。
