Bigliardi Guido, Dell'Acqua Maria Luisa, Vallone Stefano, Barbi Filippo, Pentore Roberta, Picchetto Livio, Carpeggiani Paolo, Nichelli Paolo, Zini Andrea
Stroke Unit-Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
Stroke Unit-Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
J Stroke Cerebrovasc Dis. 2016 Aug;25(8):2016-8. doi: 10.1016/j.jstrokecerebrovasdis.2016.04.019. Epub 2016 May 27.
Internal carotid artery occlusion (ICAO) is defined as "untouchable" by all specialists; no treatment is indicated because intervention risks (carotid endarterectomy (CEA) or endovascular treatment) are usually much more than benefits.(1,2) We report the case of a patient admitted to our hospital with an atherothrombotic ischemic stroke due to symptomatic acute ICAO, who developed a recurrent stroke with hemispheric hypoperfusion and was treated in the emergency department with ICAO revascularization after 60 days of occlusion finding.
D.G., a 62-year-old man, came to our attention for a transient episode of left weakness and hypoesthesia. The electrocardiogram revealed a new diagnosis of atrial fibrillation. CT angiography showed right ICAO; computed tomography and magnetic resonance imaging studies with perfusion imaging revealed a severe hemispheric hypoperfusion. Full anticoagulation therapy was started, and antihypertensive therapy was reduced to help collateral circulation. Some weeks later, the patient was readmitted to the stroke unit for 2 episodes of left-hand weakness. Cerebral angiography confirmed right ICAO from the proximal tract to the siphon. After some days, the patient suffered a femoral hemorrhagic lesion, with active bleeding, and was treated with surgical intervention. On the following day, the patient presented with left hemiplegia with hemianesthesia (National Institutes of Health Stroke Scale score = 14). The patient was treated in the emergency department with a complex endovascular treatment with complete recanalization of ICAO by positioning 3 stents through the intravenous infusion of abciximab. After intensive rehabilitation, at the 3- and 6-month follow-up evaluations, the patient regained autonomy.
In literature, treatment of chronic ICAO is not indicated. Endovascular recanalization may be beneficial to patients with chronic cerebral hypoperfusion due to ICAO, when all conservative medical therapies have failed.
颈内动脉闭塞（ICAO）被所有专家定义为“不可触及”；由于干预风险（颈动脉内膜切除术（CEA）或血管内治疗）通常远大于益处，因此不建议进行治疗。（1,2）我们报告了一例因症状性急性ICAO导致动脉粥样硬化性缺血性中风而入住我院的患者，该患者出现了伴有半球灌注不足的复发性中风，并在闭塞发现60天后在急诊科接受了ICAO血运重建治疗。
D.G.，一名62岁男性，因短暂性左侧无力和感觉减退前来就诊。心电图显示新诊断为房颤。CT血管造影显示右侧ICAO；计算机断层扫描和磁共振成像灌注成像研究显示严重的半球灌注不足。开始了全面的抗凝治疗，并减少了降压治疗以帮助侧支循环。几周后，患者因左手无力发作2次再次入住卒中单元。脑血管造影证实右侧ICAO从近端至虹吸段。几天后，患者出现股骨出血性病变，伴有活动性出血，并接受了手术干预。次日，患者出现左侧偏瘫伴偏身感觉障碍（美国国立卫生研究院卒中量表评分=14）。患者在急诊科接受了复杂的血管内治疗，通过静脉输注阿昔单抗置入3个支架，使ICAO完全再通。经过强化康复治疗，在3个月和6个月的随访评估中，患者恢复了自主能力。
在文献中，不建议对慢性ICAO进行治疗。当所有保守药物治疗均失败时，血管内再通可能对因ICAO导致慢性脑灌注不足的患者有益。
