颈内动脉球囊闭塞术后产生对侧新生动脉瘤

Contralateral de novo cerebral aneurysm following detachable balloon occlusion of ipsilateral internal carotid artery

目的在国内文献中首次报道1例床突旁动脉瘤(AN)病人在行载瘤动脉球囊闭塞术后5年出现对侧后交通AN并破裂。方法行急诊手术夹闭该新生动脉瘤。结果病人仍死于严重的颅内高压。回顾文献共发现29例35个因颈动脉闭塞术后出现的新生AN,主要位于前、后交通动脉。结论颈动脉闭塞后对侧血流代偿性增加可能是导致AN的原因,对大型AN应尽量采用保留载瘤动脉的方法;如闭塞载瘤动脉,应进行长期的影像学随访。

objective A 49-year-old female patient with left internal carotid-paraclinoid aneurysm underwent occlusion of internal carotid artery (ICA) with a detachable balloon. Five years later, she suffered severe subarachnoid hemorrhage due to a ruptured contralateral de novo internal carotid-posterior communicating artery aneurysm. Methods An emergent clipping operation was done. Results The patient still died from severe elevation of intracranial pressure. A review of the 29 report cases including ours, 35 de novo cerebral aneurysms were found after the ligation or balloon occlusion of ipsilateral ICA. The main sites of de novo aneurysms are anterior or posterior communicating artery. Conclusion Increased blood flow in contralateral ICA following occlusion of ipsilateral ICA is the main cause of de novo aneurysms. Keeping patency of the parent artery and as good as possible should be consider when deal with large or giant cerebral aneurysm. Patients who have been submitted to occlusion of parent artery should be followed up long term after therapy.