Ato Fuminori, Ohshima Tomotaka, Miyachi Shigeru, Matsuo Naoki, Kawaguchi Reo, Takayasu Masakazu
Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan.
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Asian J Neurosurg. 2019 Jul-Sep;14(3):1040-1043. doi: 10.4103/ajns.AJNS_28_19.
A 75-year-old man presented with right-sided hemiplegia and was diagnosed with a left middle cerebral artery occlusion. He underwent endovascular thrombectomy, and a bulge was found. A modified pigtail-shaped microguidewire (MPMGW) proved useful for diagnosis because it allowed differentiation between the occluded artery and a saccular aneurysm as the etiology. When a clot was partially retrieved, a previously unidentified vessel dilatation appeared. The dilatation origin was unclear and could have resulted from either the occluded artery or an unruptured saccular aneurysm. We tried to navigate the MPMGW into the bulging area. The patient showed unusual body movement attributed to pain and the dilatation was diagnosed as an aneurysm. Subsequent 3-dimensional angiography revealed a recanalized artery and the aneurysm. With no subarachnoid hemorrhage or extravasation of the contrast medium. The hemiplegia dramatically improved. An MPMGW may be useful in acute thrombectomy where the target vessel cannot be visualized during the procedure.
一名75岁男性因右侧偏瘫就诊，被诊断为左侧大脑中动脉闭塞。他接受了血管内血栓切除术，术中发现一个膨出物。一种改良的猪尾形微导丝（MPMGW）被证明有助于诊断，因为它能够区分闭塞动脉和作为病因的囊状动脉瘤。当部分取出血栓时，出现了一个先前未被识别的血管扩张。扩张的起源不明，可能是由闭塞动脉或未破裂的囊状动脉瘤引起的。我们试图将MPMGW导航至膨出区域。患者因疼痛出现异常身体活动，该扩张被诊断为动脉瘤。随后的三维血管造影显示一条再通动脉和动脉瘤。无蛛网膜下腔出血或造影剂外渗。偏瘫症状显著改善。MPMGW在急性血栓切除术中可能有用，即在手术过程中目标血管无法可视化的情况下。
