Amuluru Krishna, Romero Charles E, Pyle Logan, El-Ghanem Mohammad, Al-Mufti Fawaz
Department of Interventional Neuroradiology, University of Pittsburgh Medical Center-Hamot, Erie, Pennsylvania, USA.
Department of Interventional Neuroradiology, University of Pittsburgh Medical Center-Hamot, Erie, Pennsylvania, USA.
World Neurosurg. 2018 Apr;112:46-52. doi: 10.1016/j.wneu.2018.01.038. Epub 2018 Jan 12.
A cross-circulation technique involves gaining access to a cerebral vessel through a patent anterior or posterior communicating artery. This technique may be used in patients with emergent large-vessel occlusions and an unfavorable direct route to the occlusion. While few previous reports have demonstrated a successful cross-circulation technique for treatment of emergent large-vessel occlusions, we present the first 2 cases of transanterior communicating artery stent retriever thrombectomy.
Case #1: A 64-year-old female presented with acute right middle cerebral artery (MCA) occlusion. She demonstrated a "triple-tandem" brachiocephalic-internal carotid artery-middle cerebral artery occlusion, thus precluding direct access to the right MCA. Successful stent retriever mechanical thrombectomy was performed across the anterior communicating artery, using a left internal carotid artery approach. Case #2: A 70-year old female presented with acute occlusion of the left MCA and tandem occlusion of the cervical left internal carotid artery. Multiple attempts to catheterize the left common carotid artery were unsuccessful. She underwent successful stent retriever mechanical thrombectomy across a patent anterior communicating artery, using a right internal carotid artery approach.
Timely recanalization of an occluded artery plays a critical role in the prognosis of patients with acute ischemic stroke. Successful stent retriever mechanical thrombectomy of an occluded MCA is possible using a transanterior communicating artery approach in patients without a direct access route to the occluded intracranial vessel. We review the pathophysiology of tandem lesions, access routes to intracranial occlusions, and the literature on cross-circulation techniques to treat emergent large-vessel occlusions.
交叉循环技术是通过开放的前交通动脉或后交通动脉进入脑血管。该技术可用于急性大血管闭塞且无法通过直接途径到达闭塞部位的患者。虽然此前鲜有报道成功运用交叉循环技术治疗急性大血管闭塞，但我们报告了首例经前交通动脉支架取栓术的2例病例。
病例1：一名64岁女性，出现急性右侧大脑中动脉（MCA）闭塞。她表现为“串联三重”头臂干-颈内动脉-大脑中动脉闭塞，因此无法直接进入右侧MCA。采用经左颈内动脉途径，成功通过前交通动脉进行了支架取栓机械血栓切除术。病例2：一名70岁女性，出现左侧MCA急性闭塞及左侧颈内动脉串联闭塞。多次尝试经皮穿刺左颈总动脉均未成功。采用经右颈内动脉途径，成功通过开放的前交通动脉进行了支架取栓机械血栓切除术。
闭塞动脉的及时再通对急性缺血性脑卒中患者的预后起着关键作用。对于无法直接进入闭塞颅内血管的患者，采用经前交通动脉途径成功进行支架取栓机械血栓切除术治疗闭塞的MCA是可行 的。我们回顾了串联病变的病理生理学、颅内闭塞的入路以及治疗急性大血管闭塞的交叉循环技术的文献。
