Wang Rongfei, Weng Luankun, Li Mengzhen
Brain Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China.
Ann Transl Med. 2020 Apr;8(7):508. doi: 10.21037/atm.2020.03.77.
Intracranial vasa vasorum (VV) are rare and develop predominantly in the proximal segments of the internal carotid artery (ICA) and vertebral artery (VA). The typical appearance of intracranial VV has not yet been reported in clinical practice. Although VV in the ICA have been found to re-institute the collateral flow, bypassing the obstructive segment, far less attention has been paid to the manner in which VV can connect the two ends of the obstructive segment through the plaque. In this study, we present two cases and discuss the positive effects of VV. In our first case, a patient with basilar artery (BA) occlusion and multiple infarcts in the posterior circulation territory received endovascular treatment. Digital subtraction angiography (DSA) showed the existence of VV, which originated from the proximal BA lumen, penetrated through the vessel wall, bypassed the obstructive segment, re-penetrated through the vessel wall, and reconnected to the distal BA lumen. Balloon angioplasty was performed, specifically avoiding the path of the VV, then the VV had disappeared in follow-up angiography. In our second case, a patient who had been diagnosed with occlusion in the initial segment of the left ICA two years ago suffered a stroke. DSA revealed that the VV collaterals penetrated directly through the plaque of obstructive site and reconnected to the distal vessel lumen, which caused low hemodynamic compensation. Angioplasty was performed directly following the VV path, then follow-up angiography showed the VV had disappeared. Arterial occlusion, including in the intracranial and extracranial artery, could trigger the occurrence of VV, which can improve downstream perfusion. VV also could play a role of signal light in endovascular treatment.
颅内血管滋养血管（VV）较为罕见，主要发生在颈内动脉（ICA）和椎动脉（VA）的近端节段。颅内VV的典型表现尚未在临床实践中报道。尽管已发现ICA中的VV可重新建立侧支循环，绕过阻塞段，但对于VV如何通过斑块连接阻塞段两端的方式关注较少。在本研究中，我们展示了两个病例并讨论了VV的积极作用。在我们的第一个病例中，一名基底动脉（BA）闭塞且后循环区域有多处梗死的患者接受了血管内治疗。数字减影血管造影（DSA）显示存在VV，其起源于近端BA管腔，穿透血管壁，绕过阻塞段，再次穿透血管壁，并重新连接到远端BA管腔。进行了球囊血管成形术，特别避开了VV的路径，随后在随访血管造影中VV消失。在我们的第二个病例中，一名两年前被诊断为左ICA起始段闭塞的患者发生了中风。DSA显示VV侧支直接穿透阻塞部位的斑块并重新连接到远端血管腔，这导致了低血流动力学代偿。沿着VV路径直接进行了血管成形术，随后随访血管造影显示VV消失。动脉闭塞，包括颅内和颅外动脉的闭塞，可触发VV的发生，其可改善下游灌注。VV在血管内治疗中也可起到信号灯的作用。
