Masuo Osamu, Terada Tomoaki, Matsuda Yoshikazu, Ogura Mitsuhiro, Tsumoto Tomoyuki, Yamaga Hiroo, Itakura Toru
Department of Neurological Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Japan.
Neurol Med Chir (Tokyo). 2006 Oct;46(10):495-9. doi: 10.2176/nmc.46.495.
A 71-year-old male presented with severe left cervical internal carotid artery stenosis manifesting as repeated transient ischemic attacks consisting of right hemiparesis and motor aphasia. Carotid artery stenting (CAS) under distal protection was performed to prevent further ischemic events. This procedure was uneventful. However, the patient exhibited progressive right hemiparesis and motor aphasia 3 days after CAS. Emergent angiography revealed carotid artery occlusion due to in-stent thrombosis. In-stent percutaneous transluminal angioplasty (PTA) was performed under distal protection. The carotid artery was recanalized with small residual thrombus. The neurological deficits almost completely disappeared after PTA. Follow-up angiography 9 months after stenting showed restenosis but no in-stent thrombosis. Carotid thrombosis after CAS can be resolved by in-stent PTA under distal protection and subsequent treatment with antithrombotic agents.
一名71岁男性因严重的左侧颈内动脉狭窄就诊，表现为反复发作的短暂性脑缺血发作，症状包括右侧偏瘫和运动性失语。为预防进一步的缺血事件，在远端保护下进行了颈动脉支架置入术（CAS）。该手术过程顺利。然而，患者在CAS术后3天出现进行性右侧偏瘫和运动性失语。急诊血管造影显示因支架内血栓形成导致颈动脉闭塞。在远端保护下进行了支架内经皮腔内血管成形术（PTA）。颈动脉再通，残留少量血栓。PTA术后神经功能缺损几乎完全消失。支架置入术后9个月的随访血管造影显示有再狭窄，但无支架内血栓形成。CAS术后的颈动脉血栓形成可通过在远端保护下进行支架内PTA并随后使用抗血栓药物治疗来解决。
