Reznik Michael E, Espinosa-Morales Aixa Damaris, Jumaa Mouhammad A, Zaidi Syed, Ducruet Andrew F, Jadhav Ashutosh P
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
J Neurointerv Surg. 2017 Jan;9(1):17-20. doi: 10.1136/neurintsurg-2016-012397. Epub 2016 May 19.
Recent studies have validated the use of endovascular thrombectomy in large vessel ischemic stroke provided patients are selected appropriately. However, to our knowledge, there have been no previously reported cases of endovascular thrombectomy in patients with aortic dissection. We report three such cases, two with chronic aortic dissections (including one with a history of Marfan syndrome) and another with an acute type B dissection.
Case studies and review of relevant literature.
Three patients with a history of aortic dissection presented with acute onset right middle cerebral artery syndromes, two of whom had chronic aortic dissections that were status-post graft repair, while a third had an acute type B aortic dissection that had been managed with a femoral-to-femoral bypass. None of the three were candidates for intravenous tissue plasminogen activator. All three were found to have proximal right M1 occlusions on non-invasive imaging and were taken for endovascular thrombectomy via transfemoral, transradial, and transbrachial approaches, respectively. All three had successful recanalization (with Thrombolysis In Cerebral Infarction (TICI) 2b, TICI 3, and TICI 2b flow, respectively) along with clinical improvement, and none had procedure-related complications.
These three cases suggest that endovascular thrombectomy is feasible and can be done safely and efficaciously in patients with aortic dissections and those with Marfan syndrome, although the risks and benefits should be considered as part of any decision-making process. Given that endovascular therapy for acute stroke is now in many situations part of standard care, further studies will be necessary to delineate more precise inclusion and exclusion criteria.
近期研究证实，在适当选择患者的情况下，血管内血栓切除术可用于治疗大血管缺血性卒中。然而，据我们所知，此前尚无主动脉夹层患者接受血管内血栓切除术的报道。我们报告三例此类病例，其中两例为慢性主动脉夹层（包括一例有马凡综合征病史者），另一例为急性B型夹层。
病例研究及相关文献回顾。
三名有主动脉夹层病史的患者突发右侧大脑中动脉综合征，其中两例为慢性主动脉夹层，曾接受移植修复手术，第三例为急性B型主动脉夹层，接受了股-股旁路手术。这三名患者均不符合静脉注射组织纤溶酶原激活剂的条件。通过无创影像学检查发现，三例患者均存在右侧M1段近端闭塞，分别经股动脉、桡动脉和肱动脉途径接受了血管内血栓切除术。三例患者均成功实现再通（分别达到脑梗死溶栓（TICI）2b级、TICI 3级和TICI 2b级血流），且临床症状均有改善，无一例出现与手术相关的并发症。
这三例病例表明，血管内血栓切除术在主动脉夹层患者和马凡综合征患者中是可行的，且能安全有效地实施，不过在任何决策过程中都应考虑风险和益处。鉴于急性卒中的血管内治疗目前在许多情况下已成为标准治疗的一部分，有必要开展进一步研究以明确更精确的纳入和排除标准。
