Ruptured anterior communicating artery aneurysms associated with left common carotid artery occlusion due to Takayasu arteritis: an autopsy case report

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  • Yoshimura Motoi
    Department of Neuropathology, Neurological Institute, Graduate School of Medical Science, Kyushu University Department of Neurology, Neurological Institute, Graduate School of Medical Science, Kyushu University
  • Nishimura Ataru
    Department of Neurosurgery, Neurological Institute, Graduate School of Medical Science, Kyushu University
  • Arimura Koichi
    Department of Neurosurgery, Neurological Institute, Graduate School of Medical Science, Kyushu University
  • Shimogawa Takafumi
    Department of Neurosurgery, Neurological Institute, Graduate School of Medical Science, Kyushu University
  • Suzuki Satoshi O.
    Department of Neuropathology, Neurological Institute, Graduate School of Medical Science, Kyushu University
  • Mizoguchi Masahiro
    Department of Neurosurgery, Neurological Institute, Graduate School of Medical Science, Kyushu University
  • Iwaki Toru
    Department of Neuropathology, Neurological Institute, Graduate School of Medical Science, Kyushu University

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  • 高安動脈炎による左総頸動脈閉塞に合併した前交通動脈囊状動脈瘤破裂の1剖検例

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<p>We report an autopsy case of 42-year-old man with Takayasu arteritis and subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm. Radiological imaging study revealed total occlusion of left common carotid artery and left subclavian artery. Renal hypertension was also pointed out. The patient was treated with longterm therapy of corticosteroids, and vasculitis had been controlled. Autopsy findings revealed severe subarachnoid hemorrhage due to ruptured saccular aneurysms at the anterior communicating artery. No vasculitis, atherosclerosis, or dissection was observed at the intracranial arteries and the aneurysmal walls. The histological findings of the largesized arteries were compatible with Takayasu arteritis. Although left common carotid artery was almost completely occluded, left internal carotid artery was patent. There were 22 case reports of subarachnoid hemorrhage due to ruptured aneurysm complicated with Takayasu arteritis. These papers reported that the aneurysms were more common in the posterior circulation and that one or more of the cervical arteries showed stenosis or occlusion in most cases. Aneurysmal formation due to hemodynamic mechanism is generally considered, but spread of inflammatory changes to the intracranial blood vessels has also been reported. The antiplatelet therapy for Takayasu arteritis is recommended to prevent thrombosis, and the condition of patients is often complicated with hypertension. Since aneurysmal formation at the cerebral arteries is not a rare complication and fatal subarachnoid hemorrhage may occur, periodic head imaging tests may be recommended and reconstructive vascular operation may be considered in certain cases.</p>

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