Limbucci Nicola, Nappini Sergio, Rosi Andrea, Renieri Leonardo, Consoli Arturo, Mangiafico Salvatore
Interventional Neuroradiology Unit, Careggi University Hospital, Italy.
Interv Neuroradiol. 2017 Feb;23(1):69-72. doi: 10.1177/1591019916673220. Epub 2016 Oct 27.
Carotid artery dissection is a common cause of juvenile stroke. Endovascular treatment of acute stroke due to carotid dissection can be challenging, and endoluminal crossing of the dissection is sometimes impossible. We describe a case of intentional subintimal recanalisation of a cervical carotid dissection followed by intracranial thrombectomy and stenting. We report the case of a young woman with severe acute ischaemic stroke due to carotid artery dissection and intracranial embolism. After failure of endoluminal crossing of the dissected segment, intentional subintimal crossing with re-entry distally to the dissection was achieved and a stent was deployed. Then, middle cerebral artery thrombectomy was performed achieving good recanalisation. Acute thrombus formed in the bulged segment of the carotid stent and was managed with additional stent placement. The patient had a good clinical recovery. In selected cases, after failure of conventional techniques, subintimal recanalisation of carotid dissections may be performed.
颈动脉夹层是青少年中风的常见原因。因颈动脉夹层导致的急性中风的血管内治疗具有挑战性，有时无法通过夹层进行腔内穿越。我们描述了一例颈段颈动脉夹层的故意内膜下再通，随后进行颅内血栓切除术和支架置入术的病例。我们报告了一名年轻女性因颈动脉夹层和颅内栓塞导致严重急性缺血性中风的病例。在夹层段腔内穿越失败后，成功进行了故意内膜下穿越并在夹层远端重新进入，然后置入了支架。随后，进行了大脑中动脉血栓切除术，实现了良好的再通。颈动脉支架膨出段形成急性血栓，通过额外置入支架进行处理。患者临床恢复良好。在某些选定的病例中，在传统技术失败后，可以进行颈动脉夹层的内膜下再通。
