Arkuszewski Michal, Targosz-Gajniak Magdalena, Swiat Maciej, Baron Jan, Zbroszczyk Milosz, Jaworski Maciej, Pieta Malgorzata, Gruszczynska Katarzyna, Opala Grzegorz
Department of Neurology, Medical University of Silesia, Katowice, Poland.
Neurologist. 2012 Sep;18(5):290-5. doi: 10.1097/NRL.0b013e318266f5ba.
Intracranial atherosclerotic disease is one of the major risk factors of ischemic stroke. Percutaneous transluminal angioplasty with stent deployment may be effective for the treatment of symptomatic intracranial stenosis, however its value is yet to be determined. High possibility of serious periprocedural complications, such as acute in-stent thrombosis or stroke, narrows the current recommendations for this treatment to patients with high-grade stenosis (>70%), and to experienced neurointerventional centers.
We present a 44-year-old male with symptomatic high-grade stenosis of the M1 segment of left middle cerebral artery, treated with percutaneous transluminal angioplasty with stenting. The procedure was complicated with acute in-stent thrombosis treated with intra-arterial thrombolysis, which resulted in a nondisabling stroke.
The procedure-related stroke in this patient was probably caused by middle cerebral artery perforator ostium occlusion with balloon predilatation and transient in-stent thrombosis related to insufficient antiplatelet pretreatment. Exhausted cerebrovascular reserve due to long-lasting high-grade intracranial stenosis should also be considered as a factor contributing to ischemic complications.
颅内动脉粥样硬化疾病是缺血性卒中的主要危险因素之一。经皮腔内血管成形术加支架置入术可能对有症状的颅内狭窄治疗有效，但其价值尚待确定。围手术期严重并发症（如急性支架内血栓形成或卒中）的高发生率，使得目前该治疗的推荐仅限于重度狭窄（>70%）患者以及经验丰富的神经介入中心。
我们报告一名44岁男性，患有症状性左侧大脑中动脉M1段重度狭窄，接受了经皮腔内血管成形术加支架置入治疗。该手术并发急性支架内血栓形成，经动脉内溶栓治疗，导致非致残性卒中。
该患者的手术相关卒中可能是由于球囊预扩张导致大脑中动脉穿支开口闭塞以及抗血小板预处理不足相关的短暂支架内血栓形成所致。长期重度颅内狭窄导致的脑血管储备耗竭也应被视为缺血性并发症的一个促成因素。
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