Misaki Kouichi, Uchiyama Naoyuki, Mohri Masanao, Kamide Tomoya, Tsutsui Taishi, Kanamori Naomi, Kurokawa Keisuke, Nakada Mitsutoshi
Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Acta Neurochir (Wien). 2016 Nov;158(11):2085-2088. doi: 10.1007/s00701-016-2952-8. Epub 2016 Sep 8.
This is the first report on the mechanism of pseudoaneurysm formation after withdrawal of a stent retriever. A 79-year-old woman developed cardiogenic embolization of the distal middle cerebral artery (M2). The deployed stent retriever bent because of vessel tortuosity. After withdrawal of the stent with strong resistance, complete revascularization was achieved, but an extravasation was detected at the site. Eight hours after disappearance of the extravasation, re-bleeding occurred with aneurysm-like pooling of contrast media. Direct surgical observation confirmed a pseudoaneurysm formation. The pseudoaneurysm was likely formed by avulsion of a fine vessel during withdrawal of the stent retriever at a tortuous vessel.
这是关于取出血栓支架后假性动脉瘤形成机制的首篇报道。一名79岁女性发生大脑中动脉远端（M2）的心源性栓塞。已置入的血栓支架因血管迂曲而弯曲。在强力抵抗下取出支架后，实现了完全再通，但在该部位检测到有外渗。外渗消失8小时后，造影剂呈动脉瘤样聚集，再次出血。直接手术观察证实形成了假性动脉瘤。假性动脉瘤很可能是在迂曲血管处取出血栓支架的过程中，一条细小血管被撕裂所致。
