Kaneko Mika, Tateoka Toru, Kanemaru Kazuya, Yoshioka Hideyuki, Wakai Takuma, Hashimoto Koji, Kinouchi Hiroyuki
J Neurosurg Case Lessons. 2022 Aug 8;4(6). doi: 10.3171/CASE22254.
Idiopathic extracranial internal carotid artery vasospasm (IEICAV) is a rare cerebrovascular disorder causing transient or permanent cerebral ischemia. The pathophysiology underlying this disorder is not well understood. Although various medical treatments have been tried, complete remission of vasospasm is difficult to achieve. The first case of bilateral IEICAV induced by head rotation, which was successfully treated by carotid artery stenting (CAS), was presented.
A 40-year-old woman with bilateral IEICAV had been conservatively treated for 13 years. However, transient ischemic attacks (TIAs) were not suppressed. She eventually presented with a large brain infarction in the left hemisphere and was referred to our department. Digital subtraction angiography clearly demonstrated the triggering of internal carotid artery (ICA) vasospasm by head rotation. After CAS treatment, the TIAs disappeared completely.
Clinicians should recognize that ordinary mechanical stimulation to the ICA by head rotation can induce vasospasm, and CAS should be performed for refractory IEICAV at the appropriate time to avoid cerebral infarction causing severe neurological deficits.
特发性颅外颈内动脉血管痉挛（IEICAV）是一种罕见的脑血管疾病，可导致短暂性或永久性脑缺血。这种疾病的病理生理学尚未完全明确。尽管已经尝试了各种医学治疗方法，但血管痉挛很难完全缓解。本文报告了首例因头部旋转诱发的双侧IEICAV，经颈动脉支架置入术（CAS）成功治疗。
一名患有双侧IEICAV的40岁女性接受了13年的保守治疗。然而，短暂性脑缺血发作（TIA）并未得到抑制。她最终出现了左侧大脑半球大面积脑梗死，并被转诊至我科。数字减影血管造影清楚地显示了头部旋转引发颈内动脉（ICA）血管痉挛。经过CAS治疗后，TIA完全消失。
临床医生应认识到头部旋转对ICA的普通机械刺激可诱发血管痉挛，对于难治性IEICAV应在适当时间进行CAS，以避免导致严重神经功能缺损的脑梗死。
