Intracranial carotid artery stent placement causes delayed severe intracranial hemorrhage in a patient with moyamoya disease
Intracranial carotid artery stent placement causes delayed severe intracranial hemorrhage in a patient with moyamoya disease
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DOI：
10.1136/jnis.2010.003004
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发表时间：
2011-06-01
影响因子：
4.8
通讯作者：
Haenggi, Daniel
中科院分区：
文献类型：
--
作者：
Eicker, Sven;Etminan, Nima;Haenggi, Daniel
背景：烟雾病是一种罕见的脑血管疾病，通常以进行性双侧颈内动脉远端狭窄或闭塞及其后果为特征。直接(即颅外-颅内搭桥术)或间接脑血管重建术是治疗MMD最成熟和有效的方法。本文报告一位颈内动脉支架置入术后出现迟发性严重颅内及蛛网膜下腔出血的MMD患者的病史。临床表现为18岁女性，有癫痫史、反复发作的一过性右侧偏瘫及失语症。脑血管造影和灌注CT扫描证实左侧大脑半球血流灌注受损是由于双侧颈动脉严重狭窄合并病理性侧支病变，与烟雾病相一致。左大脑床上内动脉血管内支架置入术顺利完成。治疗五小时后，患者突然出现头痛、恶心和语言障碍，CT扫描显示脑内和蛛网膜下腔出血。由于临床进一步迅速恶化，需要手术清除血肿和减压。结论本病例报道了1例年轻MMD患者行颈内动脉支架置入术后发生严重的脑出血和蛛网膜下腔出血。这一并发症可能归因于高灌注压突破现象，这是脑高流量搭桥手术后的已知并发症。因此，尽管MMD患者已进行了血管重建手术，但颅内支架的作用仍存在很大疑问。
Background Moyamoya disease (MMD) is a rare cerebrovascular disease usually characterized by progressive bilateral distal internal carotid artery stenosis or occlusion and its consequences. Direct (ie, extracranialeintracranial bypass) or indirect cerebral revascularization procedures are the most established and effective treatment strategies for MMD. The case history is presented of a patient with MMD with delayed severe intracranial and subarachnoid hemorrhage following intracranial carotid artery stent placement.Clinical presentation An 18-year-old women presented with a history of seizures, recurrent episodes of transient right hemiparesis and aphasia. Cerebral catheter angiography and perfusion CT scan with azetozaolamide challenge confirmed impaired left hemispheric perfusion due to severe bilateral carotid artery stenosis combined with pathological collaterals, consistent with moyamoya disease. Endovascular stenting of the left supraclinoidal internal cerebral artery was performed uneventfully. Five hours after treatment the patient presented with sudden headache, nausea and speech disorders and a CT scan revealed intracerebral and subarachnoid hemorrhage. Due to further rapid clinical deterioration, surgical removal of the hematoma and decompression were required. The patient's poor neurological outcome did not improve during the 2-year follow-up period.Conclusion This case report illustrates a severe intracerebral and subarachnoid hemorrhage following intracranial stenting of the internal carotid artery in a young patient with MMD. Potentially this complication could be attributed to high perfusion pressure breakthrough phenomenon, a known complication after cerebral high-flow bypass surgery. The role of intracranial stenting, despite established revascularization procedures in patients with MMD, therefore remains highly questionable.