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成功对位于小脑后下动脉双起源之间的椎动脉夹层动脉瘤进行腔内栓塞，实现顺行血流：一例报告

Successful Internal Trapping of Vertebral Artery Dissecting Aneurysm Located between Double Origin of the Posterior Inferior Cerebellar Artery, Resulting in Antegrade Blood Flow: A Case Report.

作者信息

Kimura Seigo, Komiyama Masaki, Yagi Ryokichi, Kishi Fumihisa, Ogawa Daiji, Kuroiwa Terumasa, Yamada Keiichi, Taniguchi Hirokatsu, Wanibuchi Masahiko

机构信息

Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, Osaka, Japan.

Department of Neuroendovascular Therapy, Osaka City General Hospital, Osaka, Osaka, Japan.

出版信息

J Neuroendovasc Ther. 2024;18(5):137-141. doi: 10.5797/jnet.cr.2023-0091. Epub 2024 Mar 8.

DOI:10.5797/jnet.cr.2023-0091
PMID:38808016
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11129053/
Abstract

OBJECTIVE

The double origin of the posterior inferior cerebellar artery (DOPICA) is a rare variant of PICA. Vertebral artery dissecting aneurysm (VADA) with DOPICA is an extremely rare occurrence. Herein, we report a case of VADA located between DOPICA that was successfully treated with endovascular internal trapping.

CASE PRESENTATION

A 48-year-old male, found collapsed at his workplace, was admitted to our hospital for emergency medical assistance. Head CT revealed a subarachnoid hemorrhage (Fisher group 3), and cerebral angiography revealed right VADA with DOPICA. The VADA was located distal to the proximal component of the posterior inferior cerebellar artery (PCPICA) and just proximal to the hypoplastic distal component of PICA (DCPICA). Emergency endovascular internal trapping was performed using a total of 13 coils from the distal end of the VADA to just the distal of the branching point of PCPICA. VADA was not visualized, and antegrade flow through DOPICA to the basilar artery was confirmed. Head magnetic resonance angiography (MRA) showed antegrade flow via DOPICA, and the patient was discharged home on Day 46 with a modified Rankin Scale 0.

CONCLUSION

Endovascular internal trapping for VADA with DOPICA was considered useful, especially when VADA is distal to PCPICA and proximal to DCPICA.

摘要

目的

小脑后下动脉双起源（DOPICA）是小脑后下动脉（PICA）的一种罕见变异。伴有DOPICA的椎动脉夹层动脉瘤（VADA）极为罕见。在此，我们报告一例位于DOPICA之间的VADA，经血管内原位栓塞成功治疗。

病例介绍

一名48岁男性，在工作场所被发现晕倒，因紧急医疗救助入院。头部CT显示蛛网膜下腔出血（Fisher 3级），脑血管造影显示右侧伴有DOPICA的VADA。该VADA位于小脑后下动脉近端分支（PCPICA）的远端，恰好在小脑后下动脉发育不良的远端分支（DCPICA）的近端。从VADA远端至PCPICA分支点远端共使用13个弹簧圈进行了紧急血管内原位栓塞。VADA未显影，证实有血流经DOPICA顺行至基底动脉。头部磁共振血管造影（MRA）显示血流经DOPICA顺行，患者于第46天出院，改良Rankin量表评分为0分。

结论

血管内原位栓塞治疗伴有DOPICA的VADA被认为是有效的，特别是当VADA位于PCPICA远端且在DCPICA近端时。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/8ebc7b01f090/jnet-18-137-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/4d1f23c980ad/jnet-18-137-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/6a9aa7be412e/jnet-18-137-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/71897f2dbf10/jnet-18-137-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/8ebc7b01f090/jnet-18-137-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/4d1f23c980ad/jnet-18-137-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/6a9aa7be412e/jnet-18-137-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/71897f2dbf10/jnet-18-137-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/144b/11129053/8ebc7b01f090/jnet-18-137-g004.jpg

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本文引用的文献

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Effectiveness of Intraoperative Indocyanine Green Videoangiography in Avoiding Failure in Proximal Clipping for Dissecting Vertebral Artery Aneurysm Associated with Double Origin of the Posterior Inferior Cerebellar Artery.术中吲哚菁绿血管造影术在避免与小脑后下动脉双起源相关的椎动脉夹层动脉瘤近端夹闭失败中的有效性。
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Successful endovascular treatment of a dissecting aneurysm of vertebral artery associated with double origin of the posterior inferior cerebellar artery.
成功进行血管内治疗与小脑后下动脉双起源相关的椎动脉夹层动脉瘤。
Interv Neuroradiol. 2016 Feb;22(1):62-6. doi: 10.1177/1591019915618168. Epub 2015 Nov 30.
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