Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
J Neurointerv Surg. 2014 Apr 1;6(3):e24. doi: 10.1136/neurintsurg-2012-010646.rep. Epub 2013 Apr 30.
A 62-year-old woman with atrial fibrillation underwent burr hole trephination for a chronic subdural hematoma. Two days later the patient suddenly presented with motor dysphasia and slightly decreased motor power. Time of flight MR angiography revealed distal M1 occlusion without diffusion restriction. Stent-assisted mechanical thrombectomy was attempted but failed. Post-procedure MRI illustrated a small area of diffusion restriction within the peri-insular and parietal areas. Immediate surgical embolectomy was performed but reocclusion of M1 was documented in the postoperative angiography. Stent-assisted revascularization with a Solitaire stent was conducted and immediate restoration of blood flow was observed. The patient's motor weakness and motor dysphasia recovered fully. Re-endovascular intervention can be beneficial in selected patients for acute middle cerebral artery reocclusion after surgical embolectomy when endovascular thrombectomy fails.
一位 62 岁的女性因心房颤动而行颅骨钻孔环锯术治疗慢性硬脑膜下血肿。术后 2 天，患者突然出现运动性构音障碍和运动力量轻度下降。飞行时间磁共振血管造影显示 M1 远端闭塞，无弥散受限。尝试支架辅助机械血栓切除术，但失败。术后 MRI 显示岛叶和顶叶周围有小面积弥散受限。立即进行手术取栓，但术后血管造影显示 M1 再次闭塞。进行支架辅助血管再通术，使用 Solitaire 支架，观察到血流即刻恢复。患者的运动无力和运动性构音障碍完全恢复。对于手术取栓后血管内血栓切除术失败的急性大脑中动脉再闭塞患者，当再次血管内介入治疗是有益的。
