Cobb Mary In-Ping Huang, Smith Tony P, Brown Patrick A, Gonzalez L Fernando, Zomorodi Ali R
Duke University Hospitals, Department of Neurosurgery, Durham, North Carolina.
Duke University Hospitals, Department of Radiology, Division of Interventional Radiology, Durham, North Carolina.
J Stroke Cerebrovasc Dis. 2017 May;26(5):e90-e95. doi: 10.1016/j.jstrokecerebrovasdis.2017.02.015. Epub 2017 Mar 17.
Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) occur in up to a third of patients with acute ischemic strokes undergoing endovascular mechanical thrombectomy. Understanding open neurosurgical management of associated complications with this procedure is important.
A 67-year-old man with acute onset of left hemiparesis and a tandem right ICA and MCA occlusion. He underwent carotid stent angioplasty of a stenotic ICA, followed by attempted Solitaire stent retrieval of an MCA clot. On withdrawal, the tines of the Solitaire stent lodged inside the Precise carotid stent. The patient was started on aspirin, Plavix, and heparin infusion, and underwent a carotid endarterectomy (CEA) with safe removal of the stents and primary vessel repair.
This is the first case reported to date of a Solitaire stent becoming lodged inside a Precise carotid stent, salvaged by CEA with safe removal of the stents and primary vessel repair. We discuss the timing, indication, alternatives, and technical nuances of a CEA in this setting.
在接受血管内机械取栓术的急性缺血性卒中患者中，高达三分之一会出现颈内动脉（ICA）和大脑中动脉（MCA）串联闭塞。了解该手术相关并发症的开放性神经外科处理方法很重要。
一名67岁男性，急性起病，出现左侧偏瘫，右侧ICA和MCA串联闭塞。他先接受了狭窄ICA的颈动脉支架血管成形术，随后尝试用Solitaire支架取栓MCA内的血栓。回撤时，Solitaire支架的金属丝卡在了Precise颈动脉支架内。患者开始服用阿司匹林、波立维并静脉输注肝素，然后接受了颈动脉内膜切除术（CEA），成功取出支架并完成了原发血管修复。
这是迄今为止报道的首例Solitaire支架卡在Precise颈动脉支架内的病例，通过CEA成功取出支架并完成原发血管修复。我们讨论了在此情况下CEA的时机、适应症、替代方案及技术细节。
