Nozaki Toshiki, Noda Masayuki, Ishibashi Toshihiro, Morita Akio
Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo-ku, Tokyo.
Department of Neurosurgery, Yokohama Shin-Midori General Hospital, Yokohama, Kanagawa.
Surg Neurol Int. 2020 Dec 16;11:446. doi: 10.25259/SNI_789_2020. eCollection 2020.
Acute ischemic stroke (AIS) patients have a higher prevalence of cerebral aneurysm than a healthy reference population. However, it was recently reported that cases of an unknown hidden aneurysm in AIS patients with large-vessel occlusion are rare. We report a rare case of subarachnoid hemorrhage (SAH) during mechanical thrombectomy (MT) using a stent retriever for AIS.
A 46-year-old patient with the right internal carotid artery terminal occlusion presented with the left-sided hemiparesis, hemispatial neglect, and dysarthria and underwent MT. Initial thrombectomy using a stent retriever and reperfusion catheter was unsuccessful. Angiography just before the second attempt showed SAH. Fortunately, we achieved recanalization of the thrombolysis in cerebral infarction 2b and hemostasis by lowering the blood pressure followed by coil embolization of the ruptured aneurysm. Only a few cases of ruptured aneurysms have been reported during MT using a stent retriever. Stent withdrawal is suspected to cause aneurysm rupture in cases with an unknown hidden middle cerebral artery bifurcation aneurysm.
Preinterventional detection of a hidden aneurysm is difficult. Therefore, surgeons must always consider the possibility of a hidden aneurysm rupture in vessels distal to the occlusion site and make adequate preparations for the prompt treatment of ruptured aneurysms after MT.
急性缺血性卒中（AIS）患者脑动脉瘤的患病率高于健康对照人群。然而，最近有报道称，在伴有大血管闭塞的AIS患者中，隐匿性脑动脉瘤病例罕见。我们报告1例使用支架取栓器对AIS患者进行机械取栓术（MT）期间发生蛛网膜下腔出血（SAH）的罕见病例。
1例右侧颈内动脉末端闭塞的46岁患者，表现为左侧偏瘫、偏侧空间忽视和构音障碍，接受了MT。首次使用支架取栓器和再灌注导管进行取栓未成功。第二次尝试前的血管造影显示SAH。幸运的是，我们实现了脑梗死2b级溶栓再通，并通过降低血压实现止血，随后对破裂动脉瘤进行弹簧圈栓塞。使用支架取栓器进行MT期间发生动脉瘤破裂的病例仅有少数报道。对于隐匿性大脑中动脉分叉动脉瘤病例，怀疑支架回撤会导致动脉瘤破裂。
介入前很难检测到隐匿性动脉瘤。因此，外科医生必须始终考虑闭塞部位远端血管隐匿性动脉瘤破裂的可能性，并为MT后破裂动脉瘤的及时治疗做好充分准备。
