Gramegna Laura Ludovica, Cardozo Analía, Folleco Edgar, Tomasello Alejandro
IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
BMJ Case Rep. 2020 Jan 21;13(1):e231612. doi: 10.1136/bcr-2019-231612.
Intracranial carotid artery dissections are challenging, as there are no specific guidelines for their treatment, and most research suggests solutions for treating those involving extracranial vessels. We describe a patient with an acute ischaemic stroke within the territory of the right internal carotid artery, who was found to have intracranial carotid artery dissection during the thrombectomy procedure. The dissected lumen was successfully reconstructed via deployment of a Derivo flow-diverter stent. A balloon-assisted 'jacking' manoeuvre, in which a balloon is partially inflated at the beginning of the dissection to serve as leverage, was used to overcome the challenge of navigating the microcatheter tip through the stenosis proximal to the dissection. This case demonstrates the feasibly and safety of stenting with a flow diverter in a patient with internal carotid artery dissection; however, further studies are needed to confirm this finding.
颅内颈动脉夹层具有挑战性，因为目前尚无针对其治疗的具体指南，且大多数研究提出的是针对颅外血管夹层的治疗方案。我们描述了一名在右侧颈内动脉供血区域发生急性缺血性卒中的患者，该患者在取栓手术过程中被发现存在颅内颈动脉夹层。通过植入Derivo血流导向支架成功重建了夹层管腔。采用了球囊辅助“顶推”操作，即在夹层起始处部分充盈球囊以提供杠杆作用，从而克服了将微导管尖端穿过夹层近端狭窄部位的困难。本病例证明了在颈内动脉夹层患者中使用血流导向支架进行血管内治疗的可行性和安全性；然而，需要进一步研究来证实这一发现。
