Kole Max K, Pelz David M, Lee Donald H, Jain Vivek, Spence J David, Lownie Stephen P
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada.
Can J Neurol Sci. 2005 May;32(2):257-60. doi: 10.1017/s031716710000408x.
Cervical internal carotid artery (ICA) occlusion associated with middle cerebral artery (MCA) embolic occlusion requires prompt revascularization to prevent devastating stroke. With the advent of endovascular techniques for chemical and mechanical thrombolysis, the clinical outcome of patients with major arterial occlusions will improve. Finding the most expedient pathway to the site of end organ occlusion for thrombolysis is important.
We present two cases of acute stroke secondary to thrombotic occlusion of the cervical ICA associated with MCA embolic occlusion treated with intra-arterial thrombolysis via catheter navigation through the posterior communicating artery to the site of MCA arterial occlusion. No attempt was made to transverse the occluded ICA.
Near complete restoration of flow was achieved in one patient and minimal vessel reopening was observed in the other patient. Both patients had good outcomes.
Intra-arterial thrombolysis via Circle of Willis collaterals such as the posterior communicating artery for the treatment of acute thrombotic occlusion of the cervical internal carotid artery associated with embolic occlusion of the middle cerebral artery is a therapeutic option. This treatment option avoids the potential complications of navigating through an occluded proximal internal carotid artery and may expedite reopening of the MCA.
颈内动脉（ICA）闭塞合并大脑中动脉（MCA）栓塞性闭塞需要迅速进行血管再通以预防毁灭性中风。随着化学和机械溶栓血管内技术的出现，主要动脉闭塞患者的临床结局将会改善。找到最便捷的通往终末器官闭塞部位进行溶栓的途径很重要。
我们报告两例继发于颈内动脉血栓形成性闭塞合并MCA栓塞性闭塞的急性中风病例，通过经后交通动脉导管导航至MCA动脉闭塞部位进行动脉内溶栓治疗。未尝试穿过闭塞的ICA。
一名患者实现了血流近乎完全恢复，另一名患者观察到血管轻微再通。两名患者均取得了良好的结局。
通过诸如后交通动脉等 Willis 环侧支进行动脉内溶栓治疗颈内动脉急性血栓形成性闭塞合并大脑中动脉栓塞性闭塞是一种治疗选择。这种治疗选择避免了穿过闭塞的近端颈内动脉的潜在并发症，并且可能加速 MCA 的再通。
