Abe Hiroyuki, Mori Kentaro, Fukui Issei, Tamase Akira, Yamashita Ryotaro, Takeda Mutsuki, Nakano Tatsu, Nomura Motohiro, Yamamoto Tetsuya
Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan.
Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan.
Asian J Neurosurg. 2024 Jun 5;19(2):174-178. doi: 10.1055/s-0044-1787085. eCollection 2024 Jun.
An 85-year-old woman with a history of diabetes mellitus became aware of motor weakness of the left lower extremity. Magnetic resonance imaging showed multiple small cerebral infarctions in the right corona radiata. Angiography revealed persistent primitive trigeminal artery (PPTA) originating from the right internal carotid artery (ICA) and connecting to basilar artery, and the right ICA occluded distal to PPTA. Collateral blood circulation had developed, and sufficient collateral blood flow was expected. From these findings, the right ICA was considered to show stenosis due to atherosclerotic changes before occlusion. Conservative treatment was conducted with the transoral administration of rivaroxaban. It is important to correctly diagnose the anatomy and existence of an anomalous vessel in a stroke patient, not only when endovascular treatment is planned, but also for conservative medical treatment. Rapid and accurate radiological examinations facilitate safe and effective treatment.
一位患有糖尿病的85岁女性意识到左下肢运动无力。磁共振成像显示右侧放射冠有多处小的脑梗死。血管造影显示持续性原始三叉动脉（PPTA）起源于右侧颈内动脉（ICA）并与基底动脉相连，且右侧ICA在PPTA远端闭塞。已形成侧支循环，预计侧支血流充足。根据这些发现，右侧ICA被认为在闭塞前因动脉粥样硬化改变而出现狭窄。采用经口服用利伐沙班进行保守治疗。对于卒中患者，正确诊断异常血管的解剖结构和存在情况很重要，不仅在计划进行血管内治疗时，对于保守药物治疗也是如此。快速准确的放射学检查有助于实现安全有效的治疗。
