Kazan medical journalKazan medical journalКазанский медицинский журнал0368-48142587-9359Eco-Vector1154410.17816/KMJ2019-317Clinical observationsКлинические наблюденияResearch ArticleTreatment of ischemic stroke caused by dissection and occlusion of internal carotid artery in a young patientЛечение ишемического инсульта, обусловленного диссекцией и окклюзией внутренней сонной артерии, у молодого пациентаSazanovG VСазановГригорий Вячеславовичmc_sagr@mail.ruBelokon’O SБелоконьОлег Сергеевичmc_sagr@mail.ruKrasnovA YuКрасновАнтон Юрьевичmc_sagr@mail.ruStavropol State Medical UniversityСтавропольский государственный медицинский университетStavropol Regional Clinical HospitalСтавропольская краевая клиническая больница290320191002VOL 100, NO2 (2019)ТОМ 100, №2 (2019)31732129032019Copyright ©; 2019, Sazanov G.V., Belokon’ O.S., Krasnov A.Y.Copyright ©; 2019, Сазанов Г.В., Белоконь О.С., Краснов А.Ю.2019Sazanov G.V., Belokon’ O.S., Krasnov A.Y.Сазанов Г.В., Белоконь О.С., Краснов А.Ю.http://creativecommons.org/licenses/by-nc-sa/4.0https://kazanmedjournal.ru/kazanmedj/article/view/11544

The type and etiology of stroke in young patients are known to differ from those in elderly patients, that influences the diagnosis and treatment. Dissection of cerebral arteries holds the top position in the structure of the causes of ischemic stroke in children and young people below 45 years. Currently no clear guideline on the proper treatment of this pathology exists. The article presents the case of acute ischemic stroke in a young patient (the stroke was caused by the occlusion due to dissection of the internal carotid artery) successfully treated with radiosurgical method - stenting of the cervical part of the artery with the transition to petrous segment of the left carotid artery using combined proximal and distal protection of cerebral vessels. The control of patient's state and results of angiography and ultrasound demonstrate the favourable immediate and medium-term prognosis for the patient.

Известно, что характер и этиология инсульта в молодом возрасте отличаются от таковых у пациентов пожилого возраста, что оказывает влияние на диагностику и лечение. Лидирующую позицию в структуре причин ишемического инсульта у детей и молодых людей в возрасте до 45 лет занимает диссекция церебральных артерий. На сегодняшний день не существует чёткого руководства к действию, касающегося надлежащего лечения этой патологии. В этом наблюдении представлен успешный опыт лечения острого ишемического инсульта у молодого пациента (инсульт был обусловлен окклюзией в результате диссекции внутренней сонной артерии) с применением рентгенохирургического метода лечения - стентирования шейного отдела артерии с переходом на каменистый сегмент левой внутренней сонной артерии с использованием комбинированной проксимальной и дистальной протекции церебральных сосудов. Контроль состояния пациента и данные ангиографии и ультразвукового исследования свидетельствуют о благоприятном непосредственном и средне-отдалённом прогнозе для данного пациента.

dissection of internal carotid arterystroke in a young patientstentingtreatmentдиссекция внутренней сонной артерииинсульт в молодом возрастестентированиелечениеHart R.G. Vertebral artery dissection. Neurology. 1988; 38: 987. DOI: 10.1212/WNL.38.6.987.Amarenco P., Bogousslavsky J., Caplan L.R. et al. New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc. Dis. 2009; 27: 502–508. DOI: 10.1159/000210433.Amarenco P., Bogousslavsky J., Caplan L.R. et al. New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc. Dis. 2009; 27: 502-508. DOI: 10.1159/000210433.Hart R.G., Easton J.D. Dissections. Stroke. 1985; 16: 925. DOI: 10.1161/01.STR.16.6.925.Medvedev Yu.A., Matsko D.E. Anevrizmy i poroki razvitiya sosudov mozga. T. 1. (Aneurizms and birth defects of brain vessels. Vol. 1.) Saint Petersburg. 1993: 135 p. (In Russ.)Медведев Ю.А., Мацко Д.Е. Аневризмы и пороки развития сосудов мозга. Т. 1. СПб. 1993: 135 c.Adams H.P.Jr., Bendixen B.H., Kappelle L.J. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10 172 in Acute Stroke Treatment. Stroke. 1993; 24: 35–41. DOI: 10.1161/01.STR.24.1.35.Adams H.P.Jr., Bendixen B.H., Kappelle L.J. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10 172 in Acute Stroke Treatment. Stroke. 1993; 24: 35-41. DOI: 10.1161/01.STR.24.1.35.Bassetti C., Carruzzo A., Sturzenegger M. et al. Recurrence of cervical artery dissection: A prospective study of 81 patients. Stroke. 1996; 27: 1804–1807. DOI: 10.1161/01.STR.27.10.1804.Bassetti C., Carruzzo A., Sturzenegger M. et al. Recurrence of cervical artery dissection: A prospective study of 81 patients. Stroke. 1996; 27: 1804-1807. DOI: 10.1161/01.STR.27.10.1804.DeBray J.M., Penisson-Besnier I., Emile J. Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J. Neurol. Neurosurg. Psychiatry. 1997; 63: 46–51. DOI: 10.1136/jnnp.63.1.46.DeBray J.M., Penisson-Besnier I., Emile J. Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J. Neurol. Neurosurg. Psychiatry. 1997; 63: 46-51. DOI: 10.1136/jnnp.63.1.46.Cerrato P., Grasso M., Imperiale D. et al. Stroke in young patients: etiopathogenesis and risk factors in diffe­rent age classes. Cerebrovasc. Dis. 2004; 18: 154–159. DOI: 10.1159/000079735.Cerrato P., Grasso M., Imperiale D. et al. Stroke in young patients: etiopathogenesis and risk factors in different age classes. Cerebrovasc. Dis. 2004; 18: 154-159. DOI: 10.1159/000079735.Tripathi M., Santosh V., Nagaraj D. et al. Stroke in a young man with fibromuscular dysplasia of the cranial vessels with anticardiolipin antibodies: a case report. Neurol. Sci. 2001; 22 (1): 31–35. DOI: 10.1007/s100720170034.Tripathi M., Santosh V., Nagaraj D. et al. Stroke in a young man with fibromuscular dysplasia of the cranial vessels with anticardiolipin antibodies: a case report. Neurol. Sci. 2001; 22 (1): 31-35. DOI: 10.1007/s100720170034.Yoshimoto Y., Wakai S. Unruptured intracranial vertebral artery dissection: Clinical course and serial radiographic imagings. Stroke. 1997; 28: 370. DOI: 10.1161/01.STR.28.2.370.Kalashnikova L.A. Dissection of cerebral arteries and ischemic stroke. Atmosfera. Nervnye bolezni. 2011; (2): 2–5. (In Russ.)Калашникова Л.А. Диссекция (расслоение) церебральных артерий и ишемический инсульт. Атмосфера. Нервные болезни. 2011; (2): 2-5.Mas J.L., Bousser M.G., Hasboun D. et al. Extracranial vertebral artery dissections: a review of 13 cases. Stroke. 1987; 18: 1037–1047. DOI: 10.1161/01.STR.18.6.1037.Mas J.L., Bousser M.G., Hasboun D. et al. Extracranial vertebral artery dissections: a review of 13 cases. Stroke. 1987; 18: 1037-1047. DOI: 10.1161/01.STR.18.6.1037.Silbert P.L., Mokri B., Schievink W.I. Headache and neck pain in spontaneous internal carotid and vertebral artery dissection. Neurology. 1995; 45: 1517–1522. DOI: 10.1212/WNL.45.8.1517.Silbert P.L., Mokri B., Schievink W.I. Headache and neck pain in spontaneous internal carotid and vertebral artery dissection. Neurology. 1995; 45: 1517-1522. DOI: 10.1212/WNL.45.8.1517.Hegde V., Coutinho C.M., Mitchell J.D. Dissection of the intracranial internal carotid artery producing isolated oculomotor nerve palsy with sparing of pupil. Acta. Neurol. Scand. 2002; 105: 330–332. DOI: 10.1034/j.1600-0404.2002.1c259.x.Hegde V., Coutinho C.M., Mitchell J.D. Dissection of the intracranial internal carotid artery producing isolated oculomotor nerve palsy with sparing of pupil. Acta. Neurol. Scand. 2002; 105: 330-332. DOI: 10.1034/j.1600-0404.2002.1c259.x.Baumgartner R.W., Bogousslavsky J. Clinical manifestations of carotid dissection. In: Bawngartner R.W., Bogousslavsky J., Caso V., Paciaroni M. (eds.). Handbook on cerebral artery dissection. Front. Neurol. Neurosci. Basel: Karger. 2005; 20: 70–76. DOI: 10.1159/000088151.Baumgartner R.W., Bogousslavsky J. Clinical manifestations of carotid dissection. In: Bawngartner R.W., Bogousslavsky J., Caso V., Paciaroni M. (eds.). Handbook on cerebral artery dissection. Front. Neurol. Neurosci. Basel: Karger. 2005; 20: 70-76. DOI: 10.1159/000088151.Rao A.S., Makaroun M.S., Marone L.K. et al. Long-term outcomes of internal carotid artery dissection. J. Vasc. Surg. 2011; 54: 370–374. DOI: 10.1016/j.jvs.2011.02.059.Rao A.S., Makaroun M.S., Marone L.K. et al. Long-term outcomes of internal carotid artery dissection. J. Vasc. Surg. 2011; 54: 370-374. DOI: 10.1016/j.jvs.2011.02.059.Crönlein M., Sandmann G.H., Beirer M. et al. Traumatic bilateral carotid artery dissection following severe blunt trauma: a case report on the difficulties in diagnosis and therapy of an often overlooked life-threatening injury. Eur. J. Med. Res. 2015; 20: 62. DOI: 10.1186/s40001-015-0153-1.Zinkstok S.M., Vergouwen M.D., Engelter S.T. et al. Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data. Stroke. 2011; 42: 2515–2520. DOI: 10.1161/STROKEAHA.111.617282.Zinkstok S.M., Vergouwen M.D., Engelter S.T. et al. Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data. Stroke. 2011; 42: 2515-2520. DOI: 10.1161/STROKEAHA.111.617282.Patel R.R., Adam R., Maldjian C. et al. Cervical carotid artery dissection: current review of diagnosis and treatment. Cardiol. Rev. 2012; 20: 145–152. DOI: 10.1097/CRD.0b013e318247cd15.Patel R.R., Adam R., Maldjian C. et al. Cervical carotid artery dissection: current review of diagnosis and treatment. Cardiol. Rev. 2012; 20: 145-152. DOI: 10.1097/CRD.0b013e318247cd15.Sturzenegger M., Mattle H.P., Rivoir A. et al. Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke. 1993; 24: 1910–1921. DOI: 10.1161/01.STR.24.12.1910.Sturzenegger M., Mattle H.P., Rivoir A. et al. Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke. 1993; 24: 1910-1921. DOI: 10.1161/01.STR.24.12.1910.Sturzenegger M., Mattle H.P., Rivoir A., et al. Ultrasound findings in carotid artery dissection: analysis of 43 patients. Neurology. 1995; 45: 691–698. DOI: 10.1212/WNL.45.4.691.Sturzenegger M., Mattle H.P., Rivoir A., et al. Ultrasound findings in carotid artery dissection: analysis of 43 patients. Neurology. 1995; 45: 691-698. DOI: 10.1212/WNL.45.4.691.