Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Acta Neurochir (Wien). 2024 Feb 23;166(1):103. doi: 10.1007/s00701-024-06007-z.
Autoimmune vasculitides affect the cerebral vasculature significantly in a considerable number of cases. When immunosuppressive treatments fail to prevent stenosis in cerebral vessels, treatment options for affected patients become limited. In this case series, we present four cases of pharmacoresistant vasculitis with recurrent transient ischemic attacks (TIAs) or stroke successfully treated with either extracranial-intracranial (EC-IC) bypass surgery or endovascular stenting. Both rescue treatments were effective and safe in the selected cases. Our experience suggests that cases of pharmacoresistant cerebral vasculitis with recurrent stroke may benefit from rescue revascularization in combination with maximum medical management.
自身免疫性血管炎在相当数量的病例中显著影响脑血管。当免疫抑制治疗未能预防脑血管狭窄时，受影响患者的治疗选择变得有限。在本病例系列中，我们报告了 4 例药物难治性血管炎伴复发性短暂性脑缺血发作（TIA）或中风的病例，这些病例通过颅外-颅内（EC-IC）旁路手术或血管内支架置入术成功治疗。这两种抢救治疗在选定的病例中均有效且安全。我们的经验表明，复发性中风的药物难治性脑血管炎病例可能受益于与最大药物治疗相结合的挽救性血运重建。
