基底动脉动脉瘤合并胚胎型大脑后动脉自发性闭塞的诊治分析(附1例报道并文献复习)

Diagnosis and treatment of patients with basilar artery aneurysm associated with spontaneous occlusion of fetal posterior cerebral artery:report of one case and literature review

目的总结基底动脉动脉瘤合并胚胎型大脑后动脉(FPCA)自发性闭塞致枕叶梗死的诊治经验,以提高此类疾病的认识,避免将FPCA残端误诊为动脉瘤。方法回顾性分析1例基底动脉动脉瘤合并FPCA自发性闭塞致枕叶梗死的临床资料。结果病人以突发右上肢麻木及视物模糊起病,外院DWI显示左侧枕叶内侧面梗死伴左侧丘脑灶样梗死,外院头颈部CTA示左侧颈内动脉后交通动脉动脉瘤(呈梭形)、基底动脉动脉瘤以及颅内多发血管硬化狭窄。我院左侧颈内动脉造影见左侧后交通动脉闭塞残端,残端远端可见中断后又部分显影,左侧大脑后动脉P1、P2均闭塞,椎动脉造影未见P1段发育,基底动脉中段动脉瘤。结合病人DWI梗死部位及术前灌注成像所示灌注失代偿区,考虑为左侧FPCA急性闭塞引起同侧枕叶梗死,CTA所谓的“梭样动脉瘤”其实为闭塞后的残端。采用双支架套叠辅助弹簧圈栓塞治疗基底动脉中段动脉瘤,出院时改良Rankin量表评分1分。结论FPCA自发性闭塞临床极其罕见,急性闭塞后是否行血管内治疗依然存在争议;应加强对其影像学特征的认识和了解,以避免将其闭塞后残端误当做动脉瘤。

Objective To summarize the experience in diagnosis and treatment of the patients with basilar artery aneurysm(BAA)associated with spontaneous occlusion of fetal posterior cerebral artery(FPCA).Methods A retrospective analysis was performed on the clinical data and radiologic data including DWI,MRI,CTA and DSA of one patient with BAA associated with spontaneous occlusion of FPCA.Results The patient developed with sudden numbness in the right upper limb and blurred vision.DWI performed in other hospital showed medial infarction of left occipital lobe and focal infarction of left thalamus.Head and neck CTA performed in other hospital showed left posterior communicating artery aneurysm,basilar artery aneurysm and multiple intracranial vascular scleroses and stenoses.The DSA via left internal carotid artery in our hospital showed the occluded stump of the left posterior communicating artery,partial visualization of the distal end of the stump,and the occlusion of P1 and P2 segments of left posterior cerebral artery.The DSA via vertebral artery in our hospital showed no development of P1 segment and BAA.Combining the patient's DWI imaging and the perfusion imaging results,it is considered that the acute occipital lobe infarction was caused by the spontaneous occlusion of left FPCA,and the left posterior communicating artery aneurysm in CTA was actually the stump of FPCA after its occlusion.The patient received double stent-assisted coil embolization for the BAA,and had modified Rankin scale score of 1 point at discharge.Conclusions Spontaneous occlusion of FPCA is extremely rare in clinic,and whether endovascular treatment should be performed after acute occlusion of PFCA is still controversial.It is necessary to strengthen the knowledge and understanding of its imaging characteristics to avoid mistaking the occluded stump as an aneurysm.