Fukumoto Kazuki, Imaoka Yukihiro, Sato Hiroki, Yoshimura Masataka, Kohyama Shinya
Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Department of Neurosurgery, Kumamoto University, Kumamoto, Japan.
Surg Neurol Int. 2025 Apr 25;16:154. doi: 10.25259/SNI_167_2025. eCollection 2025.
Intra-and extracranial artery dissections are uncommon but significant causes of ischemic stroke and subarachnoid hemorrhage (SAH). While individual dissections are well-documented, simultaneous dissections of multiple vessels leading to both hemorrhagic and ischemic strokes are extremely rare.
A 41-year-old man presented with acute onset of headache, vomiting, and loss of consciousness. Imaging revealed multiple arterial dissections involving the bilateral internal carotid arteries and vertebral arteries (VAs). The patient was diagnosed with SAH caused by a ruptured fusiform aneurysm in the left VA. Emergency endovascular trapping was performed to treat the ruptured VA aneurysm. The following day, ischemic infarctions were observed in both hemispheres, prompting the initiation of dual antiplatelet therapy for the cervical carotid artery dissection. Despite the complexity of his condition, the patient achieved functional recovery, with a modified Rankin Scale score of 3 at discharge.
Simultaneous hemorrhagic and ischemic strokes due to multiple arterial dissections pose significant diagnostic and therapeutic challenges. This case highlights the importance of individualized treatment strategies and calls for further research to establish evidence-based guidelines for managing such complex conditions.
颅内和颅外动脉夹层是缺血性卒中及蛛网膜下腔出血（SAH）的少见但重要病因。虽然个别动脉夹层有充分记录，但多支血管同时发生夹层导致出血性和缺血性卒中极为罕见。
一名41岁男性突发头痛、呕吐及意识丧失。影像学检查显示双侧颈内动脉和椎动脉（VA）均发生多处动脉夹层。患者被诊断为左椎动脉梭形动脉瘤破裂所致的SAH。紧急进行血管内栓塞治疗破裂的椎动脉动脉瘤。次日，双侧半球均出现缺血性梗死，遂开始对颈内动脉夹层进行双联抗血小板治疗。尽管病情复杂，但患者实现了功能恢复，出院时改良Rankin量表评分为3分。
多支动脉夹层导致的同时性出血性和缺血性卒中带来了重大的诊断和治疗挑战。本病例突出了个体化治疗策略的重要性，并呼吁进一步开展研究以制定针对此类复杂情况的循证管理指南。
