Sultan-Qurraie Ali, Rozansky Gregory, Cox John Andrew, Lazzaro Marc
Medical College of Wisconsin, Milwaukee, WI, USA.
Interv Neuroradiol. 2017 Aug;23(4):422-426. doi: 10.1177/1591019917706191. Epub 2017 May 8.
Introduction The efficacy of the endovascular treatment of acute ischemic stroke has been substantiated by several recent randomized clinical trials. While intra-arterial therapy has significantly evolved in recent years, anatomic cerebrovascular variants and disease burden can present challenges to timely recanalization. We present the first reported case of anterior-to-posterior mechanical clot retrieval with use of a stent retriever. Case description A 53-year-old man presented with basilar artery thrombosis. Endovascular mechanical clot retrieval was performed. The typical, antegrade, access to the basilar artery thrombus was precluded by the findings of a hypoplastic left vertebral artery and an occluded proximal right vertebral artery. Given a number of factors including the patient's worsening symptoms and the high morbidity and mortality associated with basilar stroke, cross-circulation-anterior-to-posterior-intra-arterial therapy was performed. Thrombectomy of the basilar thrombus was achieved via the right internal carotid artery and right posterior communicating artery. Conclusion To our knowledge, we report the first case of cross-circulation, anterior-to-posterior thrombectomy, with the use of a stent-retriever device. Cross-circulation stroke treatment may be beneficial in cases of proximal vessel occlusion or anatomical constraints. Larger studies will need to evaluate the safety and efficacy of these approaches.
引言 近期的多项随机临床试验证实了急性缺血性卒中血管内治疗的疗效。尽管近年来动脉内治疗有了显著进展，但解剖学脑血管变异和疾病负担可能给及时再通带来挑战。我们报告首例使用支架取栓器从前向后进行机械取栓的病例。病例描述 一名53岁男性因基底动脉血栓形成就诊。进行了血管内机械取栓。左椎动脉发育不全和右椎动脉近端闭塞的检查结果排除了进入基底动脉血栓的典型顺行路径。考虑到包括患者症状恶化以及基底动脉卒中相关的高发病率和死亡率等多种因素，进行了交叉循环——从前向后——动脉内治疗。通过右颈内动脉和右后交通动脉实现了基底动脉血栓切除术。结论 据我们所知，我们报告了首例使用支架取栓器进行交叉循环、从前向后血栓切除术的病例。交叉循环卒中治疗在近端血管闭塞或解剖学限制的情况下可能有益。需要更大规模的研究来评估这些方法的安全性和有效性。
