Kim Dong Joon, Kim Dong Ik, Byun Joon Soo, Jung Jin Young, Suh Sang Hyun, Kim Eung Yeop, Heo Ji Hoe
Department of Radiology, Research Institute of Radiological Science, Yongdong Severance Hospital, Seoul, South Korea.
Cerebrovasc Dis. 2008;26(2):184-9. doi: 10.1159/000145326. Epub 2008 Jul 15.
Tandem occlusion of the arteries at the extracranial and intracranial segments is a unique cause of ischemic stroke and is often associated with a poor prognosis. Although tandem occlusion is occasionally found during intra-arterial thrombolysis (IAT), as of yet no clear therapeutic strategy has been elucidated.
After identifying distal intradural (DIL) and proximal extradural lesions (PEL) as well as the collateral state and clot burden, IAT was performed primarily targeting DIL by navigation of the microcatheter through the PEL or a collateral pathway.
Among 147 consecutive patients who were treated with IAT for hyperacute ischemic stroke, 13 (11.4%) were identified to have tandem occlusion as the cause of stroke. Navigation of a microcatheter through occluded PEL (internal carotid artery/vertebral artery) or a collateral pathway (anterior communicating artery) to the DIL was successful in 9 patients. Of them, recanalization of the DIL could be achieved in 8 (89%). The overall recanalization rate among all patients with tandem occlusion was (62%, 8/13). A good functional outcome (modified Rankin score <or=2) at 3 months was noted in 6 patients (46.2%).
Tandem occlusion may be successfully managed by strategic thrombolysis of the DIL as the primary therapeutic target for IAT. By this strategy, the ischemic brain could be effectively and rapidly perfused.
颅外和颅内段动脉串联闭塞是缺血性卒中的一种独特病因，且常与预后不良相关。尽管在动脉内溶栓（IAT）过程中偶尔会发现串联闭塞，但迄今为止尚未阐明明确的治疗策略。
在确定硬脑膜内远端（DIL）和硬脑膜外近端病变（PEL）以及侧支循环状态和血栓负荷后，主要通过微导管经PEL或侧支循环途径导航至DIL进行IAT。
在147例接受IAT治疗的超急性缺血性卒中连续患者中，13例（11.4%）被确定为串联闭塞是卒中的病因。微导管经闭塞的PEL（颈内动脉/椎动脉）或侧支循环途径（前交通动脉）成功导航至DIL的有9例患者。其中，8例（89%）实现了DIL再通。所有串联闭塞患者的总体再通率为（62%，8/13）。6例患者（46.2%）在3个月时获得了良好的功能结局（改良Rankin量表评分≤2）。
串联闭塞可通过将DIL作为IAT的主要治疗靶点进行策略性溶栓来成功处理。通过该策略，可有效且迅速地灌注缺血脑组织。
