Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
Interv Neuroradiol. 2020 Dec;26(6):814-820. doi: 10.1177/1591019920925690. Epub 2020 May 12.
We experienced two cases of ischemic stroke resulting from carotid artery occlusion associated with acute type A aortic dissection (ATAAD), in which carotid artery stenting before the surgery for ATAAD resulted in good clinical outcomes. A 63-year-old woman was hospitalized for conscious disturbance, right hemiparesis, and total aphasia. Computed tomography of the head showed no abnormal findings. Computed tomography angiography showed ATAAD and bilateral common carotid artery occlusion. Surgery was not indicated for ATAAD because of a poor prognosis of ischemic stroke. However, carotid artery stenting of the left common carotid artery occlusion was successfully performed, and her neurological findings improved. The patient underwent hemiarch replacement for ATAAD on the day after carotid artery stenting. Her final modified Rankin Scale was 1. A 57-year-old woman was hospitalized for mild left hemiparesis. Magnetic resonance imaging showed right watershed infarction and right common carotid artery occlusion. Computed tomography angiography showed ATAAD. After hospitalization, conscious disturbance appeared and left hemiparesis worsened. Ischemic stroke indicated a poor prognosis for revascularization by surgery for ATAAD. Thus, carotid artery stenting of the right common carotid artery occlusion was performed. The patient's neurological findings improved and she underwent hemiarch replacement for ATAAD at 19 days after carotid artery stenting. Her final modified Rankin Scale was 1.
In the present cases, although ischemic stroke was serious and precluded surgical indication for ATAAD, carotid artery stenting before surgery for ATAAD resulted in good clinical outcomes. Performing carotid artery stenting before surgery for ATAAD is challenging but achievable, and is a valid treatment option depending on the individual cases.
我们遇到了两例因急性 A 型主动脉夹层（ATAAD）导致颈动脉闭塞引起的缺血性脑卒中病例，其中在 ATAAD 手术前进行颈动脉支架置入术取得了良好的临床效果。一位 63 岁女性因意识障碍、右侧偏瘫和完全性失语住院。头部计算机断层扫描未发现异常。计算机断层血管造影显示 ATAAD 和双侧颈总动脉闭塞。由于缺血性脑卒中预后不良，ATAAD 手术不适用。然而，成功地对左侧颈总动脉闭塞进行了颈动脉支架置入术，其神经功能障碍得到改善。患者在颈动脉支架置入术后的第二天接受了 ATAAD 的半弓置换术。她最终的改良 Rankin 量表评分为 1 分。一位 57 岁女性因轻度右侧偏瘫住院。磁共振成像显示右侧分水岭梗死和右侧颈总动脉闭塞。计算机断层血管造影显示 ATAAD。住院后，出现意识障碍，左侧偏瘫加重。缺血性脑卒中表明，手术治疗 ATAAD 时血管再通的预后较差。因此，对右侧颈总动脉闭塞进行了颈动脉支架置入术。患者的神经功能障碍得到改善，并在颈动脉支架置入术后 19 天接受了 ATAAD 的半弓置换术。她最终的改良 Rankin 量表评分为 1 分。
在本病例中，尽管缺血性脑卒中严重且排除了 ATAAD 的手术指征，但在 ATAAD 手术前进行颈动脉支架置入术取得了良好的临床效果。在 ATAAD 手术前进行颈动脉支架置入术具有挑战性，但可行，是一种根据具体情况有效的治疗选择。
