- 著者
- Tomoaki Akiyama Tomohiro Okuda Satoshi Inoha
- 出版者
- The Japanese Society for Neuroendovascular Therapy
- 雑誌
- Journal of Neuroendovascular Therapy (ISSN:18824072)
- 巻号頁・発行日
- pp.cr.2022-0025, (Released:2022-07-12)
- 参考文献数
- 14
Objective: Detection of acute arterial occlusion in an anomalous middle cerebral artery (MCA) is challenging in an emergency setting because of its rarity.Case Presentation: We report an 81-year-old woman who presented with acute occlusion of a duplicated middle cerebral artery (DMCA). Although the absence of the superior trunk of the left MCA was identified on preoperative imaging, initial angiography showed no typical sign of the occluded vessel. Repeated angiography eventually revealed retrograde arterial flow parallel to the other visible MCA trunk, which raised the possibility of a DMCA. The occlusion occurred at the origin of the DMCA originating from the internal carotid artery terminus, which obscured its presence. Mechanical thrombectomy was performed and achieved complete recanalization. The DMCA had two trunks of approximately equal size. The patient completely recovered within 90 days.Conclusion: Comprehensive knowledge of cerebrovascular anomalies is essential to identify the occluded branch faster and accurately and to avoid thrombectomy-related complications in endovascular recanalization therapy. Relevant DMCA anatomy and tips for identifying an occluded DMCA are discussed.
- 著者
- Tomoaki AKIYAMA Tsutomu HITOTSUMATSU
- 出版者
- The Japan Neurosurgical Society
- 雑誌
- NMC Case Report Journal (ISSN:21884226)
- 巻号頁・発行日
- vol.9, pp.255-261, 2022-12-31 (Released:2022-08-20)
- 参考文献数
- 28
First bite syndrome (FBS) is an extremely rare complication of carotid endarterectomy (CEA). FBS presents with unique characteristics, development of brief and intense pain in the ipsilateral parotid region at the first bite of each meal, and improvement with subsequent mastication. Here, we report two cases of FBS following CEA. Both cases had anatomical difficulty of a high carotid bifurcation and a high cervical lesion. The lingual and facial arteries (or their common arterial trunk) branched off the external carotid artery (ECA) close to a high carotid bifurcation. The operations required exposure of the ECA distal to these two branches and the distal internal carotid artery (ICA) with a wider range of dissection for clamping the vessels. Several days or weeks after CEA, the patients developed FBS, and their meal-related pain completely resolved in the ensuing weeks. Especially in patients with a high carotid bifurcation, several branches of the ECA tend to originate from the proximal portion of the ECA, similar to octopus arms. During CEA, in these patients, dissection around the ECA and its branches in a wider range is required for exposure of each vessel and placement of the cross-clamp. These procedures can lead to injury to the external carotid nerve and plexus, possibly causing FBS. Additionally, because of the close location of the superior cervical ganglion, external carotid nerves, and distal ICA, manipulation for exposure of the distal end of a high plaque can increase the risk of injury to the cervical sympathetic nerves.