RESUMO
BACKGROUND: There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms. In the past, stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms. Here, we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent. CASE SUMMARY: Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019. Cervical computed tomographic angiography (CTA) revealed left internal carotid artery dissection with stenosis. CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm (5 mm × 5 mm × 12 mm, 10-mm neck) that was enlarged at 4 mo (7 mm × 6 mm × 12 mm, 11-mm neck). The patient underwent SUPERA stent implantation. His condition was stable in July 2020. Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019. Cervical CTA suggested right internal carotid artery dissecting aneurysm (11 mm × 9 mm × 31 mm) complicated with severe lumen stenosis (95%). The patient underwent SUPERA stent implantation. The patient had no residual symptoms and was stable in December 2020. CONCLUSION: SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.
RESUMO
We report an extremely rare case involving a posterior arch anomaly of the atlas, causing a vertebral artery dissection (VAD) induced posterior circulation stroke. A 16-year-old girl was admitted to hospital because of new onset dizziness. VAD related multiple infarction in the posterior circulation was revealed. The congenital posterior arch anomaly of the atlas, along with instability of the atlantoaxial joint, were discovered accidentally during follow-up. This is the first case of ischemic stroke related to atlantal posterior arch aplasia and atlantoaxial instability. Although rare, it reminds us that investigation of the craniovertebral junction should be considered when stroke occurs in young patients.
Assuntos
Atlas Cervical/anormalidades , Atlas Cervical/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/diagnóstico por imagem , Adolescente , Tontura/diagnóstico por imagem , Tontura/tratamento farmacológico , Tontura/etiologia , Feminino , Humanos , Inibidores da Agregação Plaquetária/administração & dosagem , Fatores de Risco , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/tratamento farmacológico , Dissecação da Artéria Vertebral/etiologiaRESUMO
We report an extremely rare case involving a posterior arch anomaly of the atlas, causing a vertebral artery dissection (VAD) induced posterior circulation stroke. A 16-year-old girl was admitted to hospital because of new onset dizziness. VAD related multiple infarction in the posterior circulation was revealed. The congenital posterior arch anomaly of the atlas, along with instability of the atlantoaxial joint, were discovered accidentally during follow-up. This is the first case of ischemic stroke related to atlantal posterior arch aplasia and atlantoaxial instability. Although rare, it reminds us that investigation of the craniovertebral junction should be considered when stroke occurs in young patients.
