Haeren Roel Hubert Louis, Jahromi Behnam Rezai, Niemela Mika
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Limburg, Netherlands.
Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Surg Neurol Int. 2021 Jul 12;12:344. doi: 10.25259/SNI_193_2021. eCollection 2021.
Carotid artery dissections (CADs) are a relatively rare disorder, whereas intracranial aneurysms (IAs) form a common cerebrovascular pathology. Since both vascular entities share similar risk factors and associations with connective tissue and vascular disorders, a common pathogenesis has been suggested. Here, we present a case of the concomitant occurrence of a CAD and a ruptured basilar trunk aneurysm (BTA). In the discussion, we elaborate on both vascular entities and have reviewed the literature on their concomitant incidence and potential shared pathogenesis.
We present a case of a 40-year-old female patient who was admitted to our hospital because of subarachnoid hemorrhage following a minor head trauma. Imaging revealed a BTA and unilateral extracranial dissection of the internal carotid artery. Despite coiling of the aneurysm, stenting of the dissection, and antithrombotic therapy, the patient died due to extensive cerebral ischemia sequelae.
CAD and BTAs have both been associated with a vascular vulnerability but their concomitant occurrence has not been described previously. The previous studies have suggested an increased incidence of IAs in patients with a CAD and vice versa. However, the number of studies and reports on this mutual increased incidence is limited. Therefore, a shared pathogenesis seems rather speculative. In our case, we suggest that a posttraumatic CAD-induced hemodynamic alterations resulting in rupture of the saccular BTA.
颈动脉夹层（CADs）是一种相对罕见的疾病，而颅内动脉瘤（IAs）是常见的脑血管病变。由于这两种血管病变具有相似的危险因素以及与结缔组织和血管疾病的关联，因此有人提出它们具有共同的发病机制。在此，我们报告一例CAD与基底动脉主干动脉瘤（BTA）破裂同时发生的病例。在讨论中，我们详细阐述了这两种血管病变，并回顾了关于它们同时发生的发生率及潜在共同发病机制的文献。
我们报告一例40岁女性患者，因轻微头部外伤后蛛网膜下腔出血入院。影像学检查发现一个BTA和颈内动脉单侧颅外段夹层。尽管对动脉瘤进行了栓塞、对夹层进行了支架置入以及抗血栓治疗，但患者因广泛脑缺血后遗症死亡。
CAD和BTA均与血管易损性有关，但其同时发生此前尚无描述。既往研究提示CAD患者发生IA的几率增加，反之亦然。然而，关于这种相互增加发生率的研究和报告数量有限。因此，共同发病机制似乎颇具推测性。在我们的病例中，我们认为创伤后CAD引起的血流动力学改变导致了囊状BTA破裂。
