Suematsu Takuya, Kawabata Shuhei, Nishikawa Yusuke, Hirai Nobuto, Nakamura Motoki, Terada Eisaku, Kajikawa Ryuichiro, Tsuzuki Takashi
Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, Japan.
J Neurosurg Case Lessons. 2024 Aug 5;8(6). doi: 10.3171/CASE2483.
Compression of the carotid artery (CA) by hyoid bony structures, such as the hyoid bone and thyroid cartilage, during swallowing or neck rotation can induce stroke. However, no reports have described ischemic stroke caused by mechanical compression of the CA by the pharynx during swallowing.
A man with left CA stenosis developed recurrent ischemic stroke in his left hemisphere. Computed tomography angiography of the neck showed that the left common carotid artery was trapped by the hyoid bone and thyroid cartilage and that the internal carotid artery (ICA) ran in the retropharyngeal space. Angiography during swallowing of a contrast agent showed dynamic compression of the left CA posterolaterally by the pharynx during swallowing, despite the fact that the CA on the healthy right side moved anteromedially. The retropharyngeal ICA was then transposed to its normal location and endarterectomy was performed. No ischemic events occurred postoperatively, and angiography showed that the left CA now moved anteromedially during swallowing.
Movement of the pharynx during swallowing can be a risk factor for CA stenosis. It is important to evaluate the anatomical interaction between the CA and surrounding structures, as well as their dynamics, to ensure appropriate diagnosis and treatment. https://thejns.org/doi/10.3171/CASE2483.
吞咽或颈部旋转时，舌骨等舌骨结构对颈动脉（CA）的压迫可诱发中风。然而，尚无报告描述吞咽时咽部对CA机械性压迫导致的缺血性中风。
一名左侧CA狭窄的男性在其左半球发生复发性缺血性中风。颈部计算机断层血管造影显示，左颈总动脉被舌骨和甲状腺软骨压迫，颈内动脉（ICA）走行于咽后间隙。吞咽造影剂时的血管造影显示，尽管健康右侧的CA向前内侧移动，但吞咽时咽部对左侧CA后外侧产生动态压迫。随后将咽后ICA移位至正常位置并进行了内膜切除术。术后未发生缺血性事件，血管造影显示左侧CA在吞咽时现向前内侧移动。
吞咽时咽部的运动可能是CA狭窄的危险因素。评估CA与周围结构之间的解剖学相互作用及其动态变化，对于确保正确的诊断和治疗很重要。https://thejns.org/doi/10.3171/CASE2483
