Lyerly Neurosurgery / Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USA.
Lyerly Neurosurgery / Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USA.
World Neurosurg. 2019 Jul;127:387-390. doi: 10.1016/j.wneu.2019.04.114. Epub 2019 Apr 19.
Most cases of vertebral artery stenosis are treated either conservatively or surgically. When non-conservative treatment is chosen, whether to treat it with open surgery or endovascular intervention remains a topic of divergence. In the setting of endovascular therapy failure, the vertebral to common carotid artery transposition certainly is an appropriate choice to recover the posterior circulation. Like any other open surgery, it is not devoid of soft-tissue-related complications. A pseudoaneurysm following this procedure and at this particular location is a rare but lethal complication and, to the best of our knowledge, has not yet been reported.
We present the case of an 80-year-old man with previous ischemic stroke who presented to the emergency department with aphasia, right-sided weakness, and dysarthria. Invasive imaging revealed right vertebral stenosis and hypoplastic left vertebral artery that failed endovascular therapy. The patient was then treated with a right vertebral to common carotid artery transposition. During follow-up, a pseudoaneurysm was found and treated with a stent-assisted coiling.
Pseudoaneurysms at the extracranial carotid and vertebral circulation are rare and have potential for deadly outcomes. Despite several treatments available, this anatomical location requires endovascular therapy due to efficacy and promptitude of this treatment. This is an interesting case where the patient's management required open and endovascular procedures. The pseudoaneurysm was a rare complication that, to the best of our knowledge, has not previously been reported. This case is an illustration of complementary work between open surgery and endovascular intervention.
大多数椎动脉狭窄病例要么采用保守治疗，要么采用手术治疗。当选择非保守治疗时，究竟是采用开放性手术还是血管内介入治疗，仍存在分歧。在血管内治疗失败的情况下，椎动脉-颈总动脉转位术肯定是恢复后循环的恰当选择。与任何其他开放性手术一样，它并非没有软组织相关并发症。在这个特定部位发生的假性动脉瘤是一种罕见但致命的并发症，据我们所知，尚未有报道。
我们报告了一例 80 岁男性患者，曾患有缺血性脑卒中，因言语不清、右侧无力和构音障碍就诊于急诊科。有创影像学显示右侧椎动脉狭窄和左侧椎动脉发育不良，血管内治疗失败。随后，患者接受了右侧椎动脉-颈总动脉转位术。随访时发现假性动脉瘤，并采用支架辅助弹簧圈治疗。
颅外颈动脉和椎动脉循环的假性动脉瘤罕见，但可能导致致命后果。尽管有多种治疗方法可用，但由于这种治疗的有效性和及时性，该解剖部位需要血管内治疗。这是一个有趣的病例，患者的治疗需要开放性手术和血管内介入治疗。假性动脉瘤是一种罕见的并发症，据我们所知，以前没有报道过。该病例说明了开放性手术和血管内介入治疗之间的互补性。
