Department of Surgical Neurology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita 010-0874, Japan.
Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai 980-8575, Japan.
Medicina (Kaunas). 2024 Sep 20;60(9):1543. doi: 10.3390/medicina60091543.
Clazosentan prevents vasospasms after aneurysmal subarachnoid hemorrhage (SAH). However, clinical data on patients with SAH with ruptured vertebral artery dissecting aneurysms (VADAs) are limited. We report the case of a 49-year-old male patient with mild-grade (WFNS grade 1) thick and diffuse (modified Fisher grade 3) SAH who underwent endovascular trapping of a ruptured VADA, resulting in a poor functional outcome with a modified Rankin Scale score of 4 due to severe symptomatic vasospasm refractory to clazosentan, requiring repeated rescue endovascular therapies and chronic communicating hydrocephalus. A retrospective analysis of the clot density in the basal and Sylvian cisterns, assessed by the Hounsfield unit (HU) values of serial CT scans, in this patient showed persistent higher values, distinct from another VADA case that showed a decline in HU values with a good clinical course. These results imply the limited effectiveness of clazosentan in cases of thick and diffuse SAH after a ruptured VADA, even in good-clinical-grade patients treated with less invasive modalities. The HU values may become a simple quantitative marker for predicting symptomatic vasospasms and chronic hydrocephalus.
克拉生坦可预防蛛网膜下腔出血（SAH）后的血管痉挛。然而，关于破裂椎动脉夹层动脉瘤（VADA）的 SAH 患者的临床数据有限。我们报告了一例 49 岁男性患者，其为轻度（WFNS 分级 1）厚且弥漫（改良 Fisher 分级 3）SAH，接受了破裂 VADA 的血管内夹闭术，由于严重的症状性血管痉挛对克拉生坦无反应，需要反复进行血管内救援治疗和慢性交通性脑积水，导致功能预后不良，改良 Rankin 量表评分为 4。对该患者的基底池和外侧裂池的血栓密度进行回顾性分析，通过连续 CT 扫描的亨氏单位（HU）值评估，发现持续存在较高的 HU 值，与另一例 HU 值下降、临床过程良好的 VADA 病例不同。这些结果表明，即使在接受侵袭性较小的治疗方式的良好临床分级患者中，克拉生坦在破裂 VADA 后发生厚且弥漫性 SAH 时的疗效有限。HU 值可能成为预测症状性血管痉挛和慢性脑积水的简单定量标志物。
