Balloon-like Mobile Plaque in the Innominate Artery: Ultrasonographic and Pathological Perspectives of Repetitive Embolism
Balloon-like Mobile Plaque in the Innominate Artery: Ultrasonographic and Pathological Perspectives of Repetitive Embolism
复制标题
无名动脉中的气球状移动斑块：重复性栓塞的超声检查和病理学视角
DOI：
10.1016/j.jstrokecerebrovasdis.2019.04.015
复制
发表时间：
2019
影响因子：
2.5
通讯作者：
Ihara Masafumi
中科院分区：
文献类型：
--
作者：
Ikenouchi Hajime;Washida Kazuo;Yoshimoto Takeshi;Fukuma Kazuki;Saito Satoshi;Inoue Yosuke;Matsuda Hitoshi;Ihara Masafumi
无名动脉内的移动的斑块极为罕见且难以诊断，尤其是在急性期。在许多情况下，其诊断往往被延误，导致治疗延误和预后不良。在此，我们报告一位69岁的病人，多发性脑梗塞只发生在右侧颈内动脉和椎基底动脉区域。直到动脉超声检查在IA中检测到大的气球样移动的斑块，才发现栓塞源。移动的斑块由高回声和低回声组成，呈气球样斑块。尽管有足够的抗血小板治疗，脑栓塞的复发仍无法预防。IA置换术最终由心脏外科医生进行。病理检查显示机化的移动的斑块可能已经存在，机化的移动的斑块的机械负荷导致动脉粥样硬化斑块破裂后形成的急性血栓可随机化的移动的斑块一起扩张，形成气球样斑块，与反复栓塞有关。在反复右侧脑栓塞的情况下，应立即探查IA，以防止进一步复发。
Mobile plaque in the innominate artery is extremely rare and difficult to diagnose, especially in its acute stage. Its diagnosis is often delayed in many cases, resulting in delayed treatment and poor prognosis. Herein, we report the case of a 69-year-old patient with multiple cerebral infarction only in the right internal carotid artery and vertebrobasilar territories. No embolic sources were found until arterial ultrasonography detected a large balloon-like mobile plaque in the IA. Mobile plaque consisted of high-and low-echoic components and showed balloon-like plaque. Despite sufficient antiplatelet therapy, recurrence of cerebral embolism could not be prevented. IA replacement was eventually performed by cardiac surgeons. Pathological examinations showed that organized mobile plaque could have existed previously and acute thrombi, generated after the atheromatous plaque rupture caused by the mechanical burden of organized mobile plaque, could expand along with the organized mobile plaque and caused balloon-like plaque and related with repeated embolism. The IA should be explored immediately in cases of repetitive right-sided cerebral embolisms to prevent further recurrence.