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一例严重颈总动脉狭窄患者在颈部放疗后发生小脑梗死。

A Case of Severe Common Carotid Artery Stenosis Who Developed Cerebellar Infarction after Cervical Irradiation.

作者信息

Sasaki Yuichi, Fuga Michiyasu, Ohara Keiichiro, Michishita Shotaro, Terao Tohru, Murayama Yuichi

机构信息

Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan.

Department of Neurosurgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan.

出版信息

J Neuroendovasc Ther. 2021;15(10):665-671. doi: 10.5797/jnet.cr.2020-0126. Epub 2021 Jan 22.

DOI:10.5797/jnet.cr.2020-0126
PMID:37502371
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10370564/
Abstract

OBJECTIVE

We report a case of cerebellar infarction caused by radiation-induced common carotid artery stenosis.

CASE PRESENTATION

The patient was a 72-year-old man who underwent irradiation for hypopharyngeal carcinoma 13 years ago. He was referred for asymptomatic left common carotid artery stenosis, but was brought to our hospital by ambulance with transient dysarthria and right facial dysesthesia 2 days after referral. Magnetic resonance imaging (MRI) revealed acute infarction in the left cerebellar hemisphere, and digital subtraction angiography (DSA) demonstrated that the blood flow in the left internal carotid artery perfused the left posterior inferior cerebellar artery (PICA) retrogradely through the left posterior communicating artery. The patient underwent carotid artery stenting (CAS) for left common carotid artery stenosis and blood flow in the left PICA improved; however, in-stent restenosis was revealed during follow-up. Percutaneous transluminal angioplasty (PTA) for in-stent restenosis was performed 9 months after the surgery.

CONCLUSION

We reported a rare case of ischemia in the PICA area caused by radiation-induced common carotid artery stenosis. Although CAS is recommended for the treatment of radiation-induced carotid artery stenosis, careful treatment and follow-up are needed to prevent perioperative complications and detect in-stent restenosis after CAS.

摘要

目的

我们报告一例因放射诱导的颈总动脉狭窄导致的小脑梗死病例。

病例介绍

患者为一名72岁男性，13年前因下咽癌接受放疗。他因无症状性左颈总动脉狭窄前来就诊，但在就诊后2天因短暂构音障碍和右侧面部感觉异常被救护车送往我院。磁共振成像（MRI）显示左侧小脑半球急性梗死，数字减影血管造影（DSA）显示左颈内动脉血流通过左后交通动脉逆行灌注左小脑后下动脉（PICA）。患者因左颈总动脉狭窄接受了颈动脉支架置入术（CAS），左PICA血流改善；然而，随访期间发现支架内再狭窄。术后9个月对支架内再狭窄进行了经皮腔内血管成形术（PTA）。

结论

我们报告了一例罕见的因放射诱导的颈总动脉狭窄导致的PICA区域缺血病例。尽管推荐CAS用于治疗放射诱导的颈动脉狭窄，但需要仔细治疗和随访以预防围手术期并发症并检测CAS术后的支架内再狭窄。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/9f5e23db76bf/jnet-15-665-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/bb35234e76f2/jnet-15-665-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/4fd075a65315/jnet-15-665-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/86ecb23fdda0/jnet-15-665-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/fa9c53240bf9/jnet-15-665-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/15e07a9f103c/jnet-15-665-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/9f5e23db76bf/jnet-15-665-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/bb35234e76f2/jnet-15-665-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/4fd075a65315/jnet-15-665-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/86ecb23fdda0/jnet-15-665-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/fa9c53240bf9/jnet-15-665-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/15e07a9f103c/jnet-15-665-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae7d/10370564/9f5e23db76bf/jnet-15-665-g006.jpg

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