1Department of Neurosurgery.
4Department of Neurology, New York University School of Medicine, New York, New York.
Neurosurg Focus. 2019 Feb 1;46(2):E6. doi: 10.3171/2018.11.FOCUS18443.
Spontaneous cervical artery dissection (sCAD) is a major cause of stroke in young adults. Multiple sCAD is a rarer, more poorly understood presentation of sCAD that has been increasingly attributed to cervical trauma such as spinal manipulation or genetic polymorphisms in extracellular matrix components. The authors present the case of a 49-year-old, otherwise healthy woman, who over the course of 2 weeks developed progressive, hemodynamically significant, bilateral internal carotid artery and vertebral artery dissections. Collateral response involved extensive external carotid artery-internal carotid artery anastomoses via the ophthalmic artery, which were instrumental in maintaining perfusion because circle of Willis and leptomeningeal anastomotic responses were hampered by the dissection burden in the corresponding collateral vessels. Endovascular intervention by placement of Pipeline embolization devices and Atlas stents in bilateral internal carotid arteries was successfully performed. No syndromic or systemic etiology was discovered during a thorough workup.
自发性颈内动脉夹层（sCAD）是年轻人中风的一个主要原因。多发性 sCAD 是 sCAD 一种更为罕见且理解欠佳的表现形式，其越来越多归因于颈椎创伤，如脊柱推拿或细胞外基质成分的遗传多态性。作者介绍了一例 49 岁的、无其他健康问题的女性患者，她在两周的时间里逐渐出现双侧颈内动脉和椎动脉的进行性、血流动力学显著的夹层病变。侧支反应涉及广泛的颈外动脉-颈内动脉吻合，通过眼动脉进行，这对维持灌注非常重要，因为环Willis 和软脑膜吻合反应因相应侧支血管中的夹层负担而受到阻碍。通过在双侧颈内动脉内放置 Pipeline 栓塞装置和 Atlas 支架进行了血管内介入治疗。在全面检查期间未发现综合征或系统性病因。
