Kutsuna Fumiya, Kawahara Ichiro, Tanaka Fujinobu, Sadakata Eisaku, Haraguchi Wataru, Iwanaga Hiroshi
Department of Neurology, National Hospital Organization Nagasaki Medical Center.
Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
Rinsho Shinkeigaku. 2023 Jun 28;63(6):369-374. doi: 10.5692/clinicalneurol.cn-001851. Epub 2023 May 17.
We present a case of internal carotid artery (ICA) stenosis caused by mechanical stimulation by the hyoid bone (HB) and thyroid cartilage (TC). A 78-year-old man with a history of right ICA stenting four years previously was admitted for abrupt onset of dysarthria and left hemiparesis and diagnosed with ischemic stroke by magnetic resonance imaging. Three-dimensional computed tomographic angiography revealed internal carotid in-stent restenosis. Furthermore, the HB and TC contacted with the right ICA. Treatment involved antiplatelet therapy, partial HB and TC resection, and carotid artery restenting. Posttreatmently, the ICA was restored and stenosis improved. Since restenosis may occur posttreatmently in patients with carotid artery stenosis caused by mechanical stimulation of the HB and TC, it is necessary to consider treatments including not only carotid artery stenting but also partial bone structures resection and carotid endarterectomy.
我们报告一例由舌骨（HB）和甲状腺软骨（TC）机械刺激导致的颈内动脉（ICA）狭窄病例。一名78岁男性，四年前有右侧ICA支架置入史，因突然出现构音障碍和左侧偏瘫入院，磁共振成像诊断为缺血性中风。三维计算机断层血管造影显示ICA支架内再狭窄。此外，HB和TC与右侧ICA接触。治疗包括抗血小板治疗、部分HB和TC切除以及颈动脉再支架置入。治疗后，ICA恢复，狭窄改善。由于由HB和TC机械刺激引起的颈动脉狭窄患者治疗后可能发生再狭窄，因此有必要考虑不仅包括颈动脉支架置入，还包括部分骨结构切除和颈动脉内膜切除术的治疗方法。
