Cryptic recanalization of chronic vertebral artery occlusion by head rotation
Cryptic recanalization of chronic vertebral artery occlusion by head rotation
复制标题
头部旋转隐秘再通术治疗慢性椎动脉闭塞
DOI：
10.1016/j.jstrokecerebrovasdis.2016.12.034
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Nagahiro S
中科院分区：
文献类型：
--
作者：
Yagi K;Nakagawa H;Mure H;Okita S;Nagahiro S
慢性椎动脉闭塞（VAO）可能与缺血性中风有关，因为在VAO残端周围的血流停滞下形成的血栓可能迁移到大脑中。我们报道了慢性VAO相关缺血性脑卒中的新机制和一例头部旋转导致慢性VAO隐蔽性再通的患者。病例描述一名74岁的男性，尽管接受了抗血小板治疗，但仍表现为慢性右侧VAO和后循环反复缺血性栓塞性中风。患者还表现为头部向左旋转30°眩晕，表明由于C4-C5水平左椎动脉未闭（VA）受到机械压迫而导致旋转椎基底动脉功能不全。通过前路手术减压血管导致旋转椎基底动脉功能不全消失。术后计算机断层血管造影扫描证实左侧VA有充分的减压，患者的头部比术前更向左旋转。在C5-C6水平观察到他的右侧慢性VAO意外的部分再通。VAO是由于骨赘在头部中性位压迫VA所致；它是通过头部旋转释放的。我们怀疑他的反复脑梗死可归因于头部旋转相关的室间隔管腔的打开和关闭，这些通过前路切除涉及的骨赘来减压左室间隔。结论头部旋转导致的慢性VAO隐蔽性再通可导致后循环反复梗死，可通过手术减压解决。
BackgroundChronic vertebral artery occlusion (VAO) can be associated with ischemic stroke, as thrombi formed under blood flow stagnation around the stump of the VAO may migrate into the brain. We report a new mechanism of chronic VAO-associated ischemic stroke and a patient with cryptic recanalization of chronic VAO by head rotation.Case descriptionA 74-year-old man presented with chronic right VAO and repeated ischemic embolic stroke in the posterior circulation despite antiplatelet therapy. He also manifested vertigo with 30° leftward head rotation, indicative of rotational vertebrobasilar insufficiency due to mechanical compression of the patent left vertebral artery (VA) at the C4-C5 level. Surgical decompression of the vessel via the anterior approach resulted in the disappearance of his rotational vertebrobasilar insufficiency. Adequate decompression of the VA on the left side was confirmed on postoperative computed tomography angiography scans obtained with his head rotated more to the left than on preoperative scans. Unexpected partial recanalization of his right chronic VAO was observed at the C5-C6 level. VAO was due to VA compression by osteophytes at neutral head position; it was released by head rotation. We suspected that his repeated brain infarcts were attributable to head rotation-related opening and closing of the VA lumen and these decompressed the left VA by removing the implicated osteophyte via the anterior approach.ConclusionsCryptic recanalization of chronic VAO by head rotation contributed to repeated infarcts in the posterior circulation and was resolved by surgical decompression.