Guizhou Medical University, Guiyang 550000, China.
Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China.
Comput Intell Neurosci. 2022 May 19;2022:3279090. doi: 10.1155/2022/3279090. eCollection 2022.
In this study, a case of bilateral common carotid artery occlusion and aneurysm in the V4 segment of the right vertebral artery with constriction of the left vertebral artery is presented. By improving digital subtraction angiography, an elderly female patient with subarachnoid haemorrhage (SAH) was diagnosed with a V4 segment of right vertebral artery aneurysm, a microaneurysm at the beginning of basilar aneurysms, bilateral common carotid artery occlusion, and narrowing vessel of left vertebral artery (DSA). Through the compensation of the basilar artery, the bilateral vertebral arteries provide intracranial and extracranial blood. Because the vertebral artery is narrowed, the right vertebral artery has priority in intracranial and extracranial blood delivery. Many members of the patient's immediate family have vasculitis, which has yet to be proven by appropriate laboratory testing but is thought to be the major cause of big artery occlusion. After cerebral angiography, the major source of this subarachnoid haemorrhage was determined to be a V4 segment of right vertebral artery aneurysm. Endovascular stent-assisted coil embolization was used to treat a V4 section of the right vertebral artery aneurysm. Because the basilar aneurysm was distal to the artery, interventional embolization was difficult to do, and it was not the major cause of the subarachnoid haemorrhage, the patient was advised to have follow-up surveillance, and she recovered well following the procedure. The combination of endovascular intervention of bilateral common carotid artery blockage and V4 segment of right vertebral artery aneurysm yielded excellent clinical outcomes in this instance. Endovascular treatment of a bilateral common carotid artery blockage paired with a V4 segment of a right vertebral artery aneurysm yielded excellent clinical outcomes in this patient, although long-term follow-up is necessary.
本研究报道了 1 例右侧椎动脉 V4 段双侧颈总动脉闭塞伴动脉瘤及左侧椎动脉狭窄病例。通过改进数字减影血管造影（DSA），诊断 1 例老年女性蛛网膜下腔出血（SAH）患者存在右侧椎动脉 V4 段动脉瘤、基底动脉瘤起始处微小动脉瘤、双侧颈总动脉闭塞和左侧椎动脉狭窄（DSA）。通过基底动脉代偿，双侧椎动脉为颅内和颅外提供血液。由于椎动脉狭窄，右侧椎动脉优先为颅内和颅外供血。患者直系亲属中有许多成员患有血管炎，但尚未通过适当的实验室检查证实，但被认为是大血管闭塞的主要原因。脑血管造影后，确定该蛛网膜下腔出血的主要原因为右侧椎动脉 V4 段动脉瘤。采用血管内支架辅助线圈栓塞治疗右侧椎动脉 V4 段动脉瘤。由于基底动脉瘤位于动脉远端，介入栓塞较困难，且不是蛛网膜下腔出血的主要原因，建议患者进行随访观察，术后患者恢复良好。在本例中，双侧颈总动脉闭塞和右侧椎动脉 V4 段动脉瘤的血管内介入联合治疗取得了良好的临床效果。虽然需要长期随访，但对于双侧颈总动脉闭塞合并右侧椎动脉 V4 段动脉瘤的患者，采用血管内治疗可获得良好的临床效果。
