Abstract

Purpose/aim of the study: Posterior circulation stroke (PCS) accounts for 20% of ischemic stroke, and vertebrobasilar stenosis is an important cause of PCS. Notably, not all patients with artery stenosis progress to ischemic stroke, and one of the important reason is that collateral circulation construction plays important protection role in this process.

Clinical presentation: Here, we present the case of a 71-year-old male who presented with lightheadedness and three episodes of loss of consciousness after bilateral subclavian artery stenting. Digital subtraction angiography (DSA) demonstrated severe stenosis of the left vertebral artery, and the bilateral subclavian artery was kept open. The patient was then given the left vertebral artery stenting in an effort to resolve the vascular stenosis. As expected, he achieved a complete remission after stenting. However, 6 months later the patient suffered from loss of consciousness again. Repeat DSA confirmed restenosis of the left vertebral artery, and revealed a collateral flow to the left vertebral artery which fed by external carotid collateral branches. Then DSA was performed after 12 months, and another collateral circulation involving thyrocervical trunk was also found supplying flow to the left vertebral artery. In this process, the frequency of loss of consciousness gradually decreased as the collateral circulation construction. Conclusion: Through this case, we observe the whole process of the collateral circulation construction. Moreover, this case serves as a testament to the variability and complexity of vertebrobasilar arteriopathies, suggesting promotion of collateral flow offers the opportunity for outcome improvement.

摘要

研究目的/目的：后循环卒中（PCS）占缺血性卒中的20%，椎基底动脉狭窄是PCS的重要原因。值得注意的是，并非所有动脉狭窄患者都会进展为缺血性卒中，其中一个重要原因是侧支循环建设在这一过程中起到了重要的保护作用。

临床表现：在这里，我们介绍了一名 71 岁男性的病例，他在双侧锁骨下动脉支架置入术后出现头晕和意识丧失的 3 次发作。数字减影血管造影（DSA）显示左椎动脉严重狭窄，双侧锁骨下动脉保持开放。然后，患者接受了左椎动脉支架术，以解决血管狭窄。正如预期的那样，他在支架植入后实现了完全缓解。然而，6个月后，患者再次失去知觉。重复DSA证实左椎动脉再狭窄，并显示侧支血流流向左椎动脉，由颈外侧支供血。然后在 12 个月后进行 DSA，还发现另一个涉及甲状腺颈干的侧支循环向左椎动脉供血。在这个过程中，随着侧支循环的建立，意识丧失的频率逐渐降低。结论：通过这个案例，我们观察了侧支循环构建的全过程。此外，该病例证明了椎基底动脉病变的可变性和复杂性，表明促进侧支循环为改善预后提供了机会。