Shimoda Kentaro, Makita Kotaro, Goto Kosei, Kido Goro, Kagawa Yukihide, Kutsuna Nobuo
Department of Neurosurgery, Kawaguchi Municipal Medical Center.
No Shinkei Geka. 2020 Dec;48(12):1171-1176. doi: 10.11477/mf.1436204341.
Traumatic carotid artery dissection(TCAD)is often associated with severe traumatic brain injuries and has high rates of morbidity and mortality. Here, we report a case of TCAD that was treated with mechanical thrombectomy followed by carotid artery stenting(CAS). A 50-year-old man suffered from minor facial trauma due to a motorcycle accident and had disturbance of consciousness with left hemiplegia 2 hours after sustaining the injury. Magnetic resonance imaging scans revealed cerebral infarction in a part of the middle cerebral artery territory, and magnetic resonance angiography showed cervical internal carotid artery occlusion. The patient was diagnosed with TCAD and underwent acute revascularization. Complete recanalization was with a combined technique using a stent-retriever and an aspiration catheter. Carotid angiography revealed a dissection of the internal carotid artery on the right side, and CAS was performed on the right side. Postoperatively, the patient recovered from disturbance of consciousness and left hemiplegia and was discharged once he was ambulatory. In cases of worsening symptomatology or worsening imaging findings, an endovascular approach should be considered for the treatment of TCAD.
创伤性颈动脉夹层(TCAD)常与严重的创伤性脑损伤相关,且发病率和死亡率较高。在此,我们报告一例采用机械取栓术随后进行颈动脉支架置入术(CAS)治疗的TCAD病例。一名50岁男性因摩托车事故遭受轻微面部创伤,受伤后2小时出现意识障碍并伴有左侧偏瘫。磁共振成像扫描显示大脑中动脉区域部分脑梗死,磁共振血管造影显示颈内动脉闭塞。该患者被诊断为TCAD并接受了急性血管再通治疗。使用支架取栓器和抽吸导管联合技术实现了完全再通。颈动脉血管造影显示右侧颈内动脉夹层,遂对右侧进行了CAS。术后,患者意识障碍和左侧偏瘫症状恢复,能够行走后出院。对于症状恶化或影像学表现恶化的TCAD病例,应考虑采用血管内治疗方法。