2023 年 46 巻 1 号 p. 26-30
Blunt cerebrovascular injury (BCVI) is rare, accounting for 1–2% of all blunt injuries, but 10–20% may develop a stroke, resulting in morbidity or mortality. Although screening criteria for diagnosis are indicated, stroke due to BCVI may occur even in cases with minor injuries that meet no criteria, and early diagnosis before the onset of a stroke is difficult. Traffic accidents are the most common cause of trauma, and 60–80% of traumatic internal carotid artery occlusion cases occur within 24 hours after the injury. Still, in rare cases, it occurs later than seven days. We experienced a tandem occlusion of the extracranial carotid artery and middle cerebral artery due to the internal carotid artery dissection 23 days after a minor traffic accident without head or neck trauma. Mechanical thrombectomy combined with intravenous administration of recombinant tissue plasminogen activator was performed, and good recanalization was obtained. Carotid artery stenting was successfully added for the residual pseudoaneurysm of the internal carotid artery seven days after the initial treatment. The patient recovered well and was transferred to another hospital for rehabilitation.
BCVI sometimes occurs even if minor injuries do not meet the previously proposed screening criteria and rarely cause a cerebral infarction more than seven days after the initial injury. Some reports recommend more comprehensive cervical vessel screening in minor trauma patients. As a treatment, especially in patients with residual stenosis or pseudoaneurysm, endovascular stenting is effective in addition to medical therapy for stroke prevention.
