Campos Jessica K, Lin Li-Mei, Beaty Narlin B, Bender Matthew T, Jiang Bowen, Zarrin David A, Coon Alexander L
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, University of California, Irvine, Orange, California, USA.
Stroke Vasc Neurol. 2018 Dec 17;4(1):43-47. doi: 10.1136/svn-2018-000187. eCollection 2019 Mar.
An estimated 2%-3% of the population harbour an intracranial aneurysm. Concomitant atherosclerotic cervical carotid disease is not uncommon. The management of these two entities remains a challenge within the field.
We report a single case of concomitant carotid stenosis and two ipsilateral unruptured intracranial aneurysms treated with a single-staged cervical carotid stenting and cerebral aneurysm embolisation with the Pipeline embolisation device.
No consensus currently exists to guide endovascular treatment of intracranial aneurysms associated with asymptomatic ipsilateral stenosis. Here, we present a case of asymptomatic moderate carotid stenosis with two ipsilateral intracranial aneurysms and suggest carotid artery stenting takes procedural priority over aneurysm embolisation in single-stage treatment. The rationale for the sequence of neurointerventions is based on the tracking a robust distal access system beyond a stenotic proximal carotid lesion and stabilisation of the ulcerated plaque to avoid thromboembolic complications associated with plaque irritation during aneurysm embolisation. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.
据估计，2% - 3%的人口患有颅内动脉瘤。同时合并颈动脉硬化性疾病并不少见。这两种疾病的治疗仍是该领域的一项挑战。
我们报告一例同时存在颈动脉狭窄和两个同侧未破裂颅内动脉瘤的病例，采用单阶段颈动脉支架置入术和使用Pipeline栓塞装置进行脑动脉瘤栓塞术治疗。
目前尚无共识指导对伴有无症状同侧狭窄的颅内动脉瘤进行血管内治疗。在此，我们展示一例无症状中度颈动脉狭窄合并两个同侧颅内动脉瘤的病例，并建议在单阶段治疗中，颈动脉支架置入术在程序上优先于动脉瘤栓塞术。神经介入治疗顺序的依据是在狭窄的近端颈动脉病变远端追踪一个强大的远端通路系统，并稳定溃疡斑块，以避免在动脉瘤栓塞过程中与斑块刺激相关的血栓栓塞并发症。需要更多病例和更长时间的随访来进一步评估该技术的疗效。
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