Matsumoto S, Yoshida S, Nakazawa K, Kang Y, Oda Y, Kawamoto M
Department of Neurosurgery, Kobe City General Hospital, Japan.
No Shinkei Geka. 1999 Feb;27(2):183-7.
The authors report the case of a 68-year-old male who underwent emergency stenting for iatrogenic occlusion of the internal carotid artery while he was receiving percutaneous transluminal angioplasty. He presented with a 1-month history of transient ischemic attacks with right-sided hemiparesis. Carotid angiography revealed a 95% eccentric stenosis at the origin of the left internal carotid artery. As the stenotic lesion was higher than the level of the third cervical vertebral body, percutaneous transluminal angioplasty was performed instead of carotid endarterectomy. During the procedure, the left internal carotid artery was dissected, then obstructed completely with rapid deterioration of his neurological condition. The Palmaz-Schatz stent was successfully deployed over the site of dissection to restore normal patency through the dissected carotid artery. Following emergency stenting, his neurological signs quickly subsided. Since then, with oral administration of antiplatelet medication, he has suffered no recurrence of cerebral ischemic events. Echo-ultrasonography 4 months after stent implantation showed good patency of the stented segment. It has been reported that angioplasty is indicated for high-risk patients or surgically inaccessible lesions in stenotic disorders of the internal carotid artery. However, there are several complications reported, including intimal dissection and restenosis. The present case emphasizes the usefulness of emergency stenting when occlusion of the internal carotid artery is complicated during percutaneous transluminal angioplasty.
作者报告了一例68岁男性病例，该患者在接受经皮腔内血管成形术时发生医源性颈内动脉闭塞，随后接受了急诊支架置入术。他有1个月的短暂性脑缺血发作病史，并伴有右侧偏瘫。颈动脉血管造影显示左颈内动脉起始处有95%的偏心性狭窄。由于狭窄病变高于第三颈椎椎体水平，因此进行了经皮腔内血管成形术而非颈动脉内膜切除术。在手术过程中，左颈内动脉发生夹层，随后完全阻塞，其神经状况迅速恶化。Palmaz-Schatz支架成功地放置在夹层部位，以恢复经夹层颈动脉的正常通畅。急诊支架置入术后，他的神经体征迅速消退。从那时起，通过口服抗血小板药物，他没有再发生脑缺血事件。支架植入4个月后的超声检查显示支架段通畅良好。据报道，血管成形术适用于颈内动脉狭窄性疾病的高危患者或手术难以到达的病变。然而，也有一些并发症的报道，包括内膜夹层和再狭窄。本病例强调了在经皮腔内血管成形术期间颈内动脉闭塞并发时急诊支架置入术的有效性。
