Ken Uekawa1,2, Yasuyuki Kaku1, Toshihiro Amadatsu1,2, Hiroaki Matsuzaki2, Yuki Ohmori1, Takayuki Kawano3, Shinya Hirata4, Tomomi Yamaguchi5,6,7, Tomoki Kosho5,6,7, Akitake Mukasa1. 1. Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan. 2. Department of Cerebrovascular Medicine & Surgery, Division of Neurosurgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan. 3. Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan. 4. Department of Rheumatology, Kumamoto University Hospital, Kumamoto, Japan. 5. Department of Medical Genetics, Shinshu University School of Medicine, Nagano, Japan. 6. Center for Medical Genetics, Shinshu University Hospital, Nagano, Japan. 7. Division of Clinical Sequence, Shinshu University School of Medicine, Nagano, Japan.
Abstract
OBJECTIVE: We describe a case of intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis (RA). CASE PRESENTATION: A 29-year-old man with a medical history of RA since 18 years of age was admitted to our hospital for vomiting, dysarthria, and conscious disturbance. At 23, he underwent ligation of the left internal carotid artery (ICA) with superficial temporal artery to middle cerebral artery anastomosis because of acute infarct of the left hemisphere caused by arterial dissection of the left ICA. During the current admission, computed tomography (CT) revealed subarachnoid hemorrhage, and digital subtraction angiography (DSA) demonstrated dissecting aneurysms of the left intracranial vertebral artery (VA) and right extracranial VA. We diagnosed him with a ruptured dissecting aneurysm of the left intracranial VA and performed endovascular parent artery occlusion on the left VA. For the right unruptured VA aneurysm, we performed coil embolization simultaneously. At 2 weeks after the endovascular treatment, follow-up DSA revealed that multiple de novo dissecting aneurysms developed on the origin of the left VA and left and right internal thoracic arteries. Those aneurysms were treated with coil embolization. Other remaining aneurysms on the left thyrocervical trunk, right transverse cervical artery, and both common iliac arteries were treated by conservative therapy. While continuing medical treatment for RA, the patient recovered and was discharged to a rehabilitation hospital. CONCLUSION: Considering that RA-induced vasculitis can be a potential risk of vascular complications including multiple arterial dissections, physicians should carefully perform endovascular interventional procedures for patients with long-term RA.
OBJECTIVE: We describe a case of intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis (RA). CASE PRESENTATION: A 29-year-old man with a medical history of RA since 18 years of age was admitted to our hospital for vomiting, dysarthria, and conscious disturbance. At 23, he underwent ligation of the left internal carotid artery (ICA) with superficial temporal artery to middle cerebral artery anastomosis because of acute infarct of the left hemisphere caused by arterial dissection of the left ICA. During the current admission, computed tomography (CT) revealed subarachnoid hemorrhage, and digital subtraction angiography (DSA) demonstrated dissecting aneurysms of the left intracranial vertebral artery (VA) and right extracranial VA. We diagnosed him with a ruptured dissecting aneurysm of the left intracranial VA and performed endovascular parent artery occlusion on the left VA. For the right unruptured VA aneurysm, we performed coil embolization simultaneously. At 2 weeks after the endovascular treatment, follow-up DSA revealed that multiple de novo dissecting aneurysms developed on the origin of the left VA and left and right internal thoracic arteries. Those aneurysms were treated with coil embolization. Other remaining aneurysms on the left thyrocervical trunk, right transverse cervical artery, and both common iliac arteries were treated by conservative therapy. While continuing medical treatment for RA, the patient recovered and was discharged to a rehabilitation hospital. CONCLUSION: Considering that RA-induced vasculitis can be a potential risk of vascular complications including multiple arterial dissections, physicians should carefully perform endovascular interventional procedures for patients with long-term RA.
Entities:
Keywords:
Intracranial and extracranial multiple arterial dissecting aneurysms; TNF-α antagonist; de novo dissecting aneurysm; endovascular treatment; rheumatoid arthritis
Authors: D M Mandell; M Mossa-Basha; Y Qiao; C P Hess; F Hui; C Matouk; M H Johnson; M J A P Daemen; A Vossough; M Edjlali; D Saloner; S A Ansari; B A Wasserman; D J Mikulis Journal: AJNR Am J Neuroradiol Date: 2016-07-28 Impact factor: 3.825
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