Kim Hyungyeol, Jin Sung-Chul, Lee Hyungon
Department of neurosurgery, Inje university, Haeundae Paik Hospital, Busan, Korea.
Department of neurosurgery, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2022 Jun;24(2):137-143. doi: 10.7461/jcen.2021.E2021.07.014. Epub 2021 Nov 3.
Simultaneous anterior cerebral artery (ACA) and middle cerebral artery (MCA) occlusion is rare. We investigated the clinical and radiological outcomes of patients with simultaneous ACA and MCA occlusion treated with mechanical thrombectomy.
We analyzed the clinical and radiological outcomes of 12 patients with simultaneous ACA and MCA occlusion treated with mechanical thrombectomy from January 2018 to December 2020. The clinical outcome was assessed using the modified Rankin Score (mRS) after 3 months of thrombectomy. The radiological outcome was assessed using the thrombolysis in cerebral infarction (TICI) score.
The median National Institutes of Health Stroke Scale score at hospital arrival was 18 (interquartile range, 16-20). M1 was the most common occlusion lesion (n=8), and A3 was the most common lesion in the ACA (n=6). Six patients were first treated for MCA occlusion and later for ACA occlusion (MCA group). Other patients were first treated for ACA occlusion and later for MCA occlusion (ACA group). There was no difference in clinical outcomes between the MCA and ACA groups (p=0.180). Successful recanalization (TICI ≥2b) of MCA was achieved in 10 patients (83.3%). Successful recanalization of ACA was achieved in 10 patients (83.3%). Successful recanalization of both ACA and MCA occlusion was observed in eight patients (66.7%). Three patients (25%) had good clinical outcomes (mRS ≤2).
In our series, simultaneous ACA and MCA occlusion showed relatively poor successful recanalization rates and poor clinical outcomes despite treatment with mechanical thrombectomy.
大脑前动脉（ACA）和大脑中动脉（MCA）同时闭塞的情况较为罕见。我们研究了接受机械取栓治疗的ACA和MCA同时闭塞患者的临床及影像学结局。
我们分析了2018年1月至2020年12月期间12例接受机械取栓治疗的ACA和MCA同时闭塞患者的临床及影像学结局。取栓术后3个月，使用改良Rankin量表（mRS）评估临床结局。使用脑梗死溶栓（TICI）评分评估影像学结局。
入院时美国国立卫生研究院卒中量表评分中位数为18分（四分位间距，16 - 20分）。M1是最常见的闭塞病变（n = 8），A3是ACA中最常见的病变（n = 6）。6例患者先接受MCA闭塞治疗，后接受ACA闭塞治疗（MCA组）。其他患者先接受ACA闭塞治疗，后接受MCA闭塞治疗（ACA组）。MCA组和ACA组的临床结局无差异（p = 0.180）。10例患者（83.3%）实现了MCA的成功再通（TICI≥2b）。10例患者（83.3%）实现了ACA的成功再通。8例患者（66.7%）观察到ACA和MCA闭塞均成功再通。3例患者（25%）获得了良好的临床结局（mRS≤2）。
在我们的系列研究中，尽管进行了机械取栓治疗，但ACA和MCA同时闭塞的成功再通率相对较低，临床结局较差。
