医学
结节性多动脉炎
动脉瘤
栓塞
海绵窦
血管炎
外科
放射科
头痛
颈内动脉
内科学
疾病
作者
Jaime L. Martínez Santos,Zul Kaderali,Julian Spears,Laurence A. Rubin,Thomas R. Marotta
出处
期刊:Case Reports
[BMJ]
日期:2015-05-29
卷期号:: bcr2015011780-bcr2015011780
被引量:7
标识
DOI:10.1136/bcr-2015-011780
摘要
Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.
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