Inoue Hiroyasu, Oomura Masahiro, Nishikawa Yusuke, Mase Mitsuhito, Matsukawa Noriyuki
Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
NMC Case Rep J. 2022 Apr 1;9:49-53. doi: 10.2176/jns-nmc.2021-0403. eCollection 2022.
Internal carotid artery occlusion rarely recanalizes spontaneously. Awareness of signs of recanalization is important, as it may necessitate changing the treatment strategy. We report a case of new cortical infarction outside the border zone, which led to the realization of internal carotid artery recanalization and revascularization. A 76-year-old woman presented with mild dysarthria. Magnetic resonance imaging showed cerebral infarction in the left-hemispheric border zone and occlusion of the internal carotid artery origin. Cerebral angiography performed showed complete occlusion of the internal carotid artery origin and intracranial collateral blood flow from the external carotid artery through the ophthalmic artery. She was diagnosed with infarction due to a hemodynamic mechanism caused by internal carotid artery occlusion and was treated with supplemental fluids and antithrombotic drugs. Four days after hospitalization, the right paralysis worsened and a new cerebral infarction was observed in the cortex, outside the border zone. This infarction appeared to be embolic rather than hemodynamic; thus, we suspected recanalization of the internal carotid artery. The patient underwent emergency cerebral angiography again, which revealed slight recanalization. Thus, emergency revascularization and carotid artery stenting were performed. New cortical infarcts outside the border zone in patients with complete internal carotid artery occlusion is an important finding, suggesting spontaneous recanalization of the occluded internal carotid artery.
颈内动脉闭塞很少会自发再通。认识到再通的迹象很重要，因为这可能需要改变治疗策略。我们报告一例发生在边缘带以外的新的皮质梗死病例，该病例促使我们认识到颈内动脉再通和血管重建。一名76岁女性出现轻度构音障碍。磁共振成像显示左侧半球边缘带脑梗死以及颈内动脉起始部闭塞。脑血管造影显示颈内动脉起始部完全闭塞，存在从颈外动脉通过眼动脉的颅内侧支血流。她被诊断为因颈内动脉闭塞导致的血流动力学机制引起的梗死，并接受了补充液体和抗血栓药物治疗。住院4天后，右侧瘫痪加重，在边缘带以外的皮质观察到新的脑梗死。这次梗死似乎是栓塞性而非血流动力学性的；因此，我们怀疑颈内动脉再通。患者再次接受急诊脑血管造影，结果显示有轻微再通。于是，进行了急诊血管重建和颈动脉支架置入术。完全性颈内动脉闭塞患者出现边缘带以外的新的皮质梗死是一个重要发现，提示闭塞的颈内动脉自发再通。
