Asai Takumi, Oyama Takahiro, Takita Wataru, Ohno Masasuke, Suzaki Noriyuki, Kajita Yasukazu, Takahashi Tatsuo
Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
Department of Neurology, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
J Neuroendovasc Ther. 2021;15(9):609-614. doi: 10.5797/jnet.cr.2020-0181. Epub 2021 Jan 11.
Azygos anterior cerebral artery (ACA) is a well-known anomaly of the second segment of the ACA. Although cases of intracerebral aneurysms related to this anomaly have been reported, acute ischemic stroke (AIS) related to the azygos ACA is extremely rare.
An 84-year-old man developed disturbance of consciousness (Glasgow Coma Scale [GCS] E3V1M5), quadriparesis and aphasia, with a National Institutes of Health Stroke Scale (NIHSS) score of 32. Magnetic resonance imaging (MRI) showed no early ischemic changes, although a head magnetic resonance angiogram (MRA) demonstrated a single A2 trunk without any A3 branches that were suspected bilateral ACA occlusions. Mechanical thrombectomy for the occluded A2 trunk with contact aspiration using a Penumbra 4MAX aspiration catheter was performed, and the clot was retrieved and complete recanalization was achieved after two attempts (Thrombolysis in Cerebral Infarction scale 3) without any complications (onset to recanalization time: 187 min). The final angiogram demonstrated the recanalization of the single A2 and bilateral A3 branches, so we diagnosed as azygos ACA occlusion. MRI performed the next day revealed several small infarctions in bilateral frontal lobes, but ischemic symptoms gradually improved. NIHSS score decreased to two in 2 weeks and modified Rankin Scale (mRS) score at 90 days was one.
In this case, occlusion of the azygos ACA led to a large ischemic penumbra that spread widely and bilaterally in the ACA area, resulting in sudden onset of severe ischemic symptoms, including quadriparesis and aphasia. However, due to complete and rapid recanalization with contract aspiration, a large part of the ACA territory bilaterally was salvaged and the patient recovered extremely well.
大脑前动脉共干（ACA）是ACA第二段一种众所周知的异常情况。虽然已报道过与这种异常相关的颅内动脉瘤病例，但与大脑前动脉共干相关的急性缺血性卒中（AIS）极为罕见。
一名84岁男性出现意识障碍（格拉斯哥昏迷量表[GCS]E3V1M5）、四肢瘫和失语，美国国立卫生研究院卒中量表（NIHSS）评分为32分。磁共振成像（MRI）未显示早期缺血改变，尽管头部磁共振血管造影（MRA）显示单一的A2主干且无任何A3分支，怀疑双侧ACA闭塞。使用Penumbra 4MAX抽吸导管对闭塞的A2主干进行接触抽吸机械取栓，经过两次尝试成功取出血栓并实现完全再通（脑梗死溶栓量表3级），无任何并发症（发病至再通时间：187分钟）。最终血管造影显示单一的A2和双侧A3分支再通，因此我们诊断为大脑前动脉共干闭塞。次日进行的MRI显示双侧额叶有几处小梗死灶，但缺血症状逐渐改善。2周时NIHSS评分降至2分，90天时改良Rankin量表（mRS）评分为1分。
在本病例中，大脑前动脉共干闭塞导致大面积缺血半暗带在ACA区域广泛双侧扩散，引发包括四肢瘫和失语在内的严重缺血症状突然发作。然而，由于通过接触抽吸实现了完全快速再通，双侧ACA区域的大部分得以挽救，患者恢复情况极佳。
