Fujimoto Kentaro, Chida Kohei, Yoshida Jun, Kojima Daigo, Yoshida Koji, Misaki Toshinari, Konno Hiromu, Ogasawara Kuniaki
Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan.
Department of Neurosurgery, Iwate Medical University, Yahaba, Iwate, Japan.
Radiol Case Rep. 2023 Aug 25;18(11):3856-3860. doi: 10.1016/j.radcr.2023.08.004. eCollection 2023 Nov.
Urgent carotid artery stenting (CAS) is effective for treatment-resistant cervical internal carotid artery dissection (CICAD). We experienced a 37-year-old woman who presented with sudden onset of cervical pain, blurred vision in the right eye, and numbness in the left upper and lower extremities. Due to neurological deterioration resulting from hemodynamic impairment, urgent CAS was performed under general anesthesia. Brain perfusion single-photon emission computed tomography performed immediately after CAS showed increased blood flow in the right hemisphere despite no evidence of hemorrhage or ischemic lesion on brain computed tomography (CT). Systolic blood pressure was therefore strictly controlled below 110 mm Hg perioperatively. However, the day after CAS, a follow-up CT showed intracerebral hemorrhage in the right temporal lobe. Urgent CAS in patients with progressive deterioration of hemodynamic impairment caused by CICAD may induce intracerebral hemorrhage due to cerebral hyperperfusion. Care should be taken to recognize and manage this phenomenon during the perioperative period.
紧急颈动脉支架置入术（CAS）对于治疗抵抗性颈内动脉夹层（CICAD）有效。我们遇到一名37岁女性，她突然出现颈部疼痛、右眼视力模糊以及左上肢和下肢麻木。由于血流动力学损害导致神经功能恶化，在全身麻醉下进行了紧急CAS。CAS术后立即进行的脑灌注单光子发射计算机断层扫描显示右半球血流增加，尽管脑部计算机断层扫描（CT）未发现出血或缺血性病变。因此，围手术期将收缩压严格控制在110 mmHg以下。然而，CAS术后第二天，随访CT显示右侧颞叶脑出血。由CICAD引起的血流动力学损害进行性恶化的患者行紧急CAS可能因脑过度灌注而诱发脑出血。围手术期应注意识别和处理这种现象。
