Arakawa Tomoya, Hiramatsu Hisaya, Kida Satoru, Sano Hiroyasu, Kenmochi Hiroaki, Akamine Souichi, Sato Haruhiko
Department of Neurosurgery, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
Department of Neurosurgery Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
NMC Case Rep J. 2021 Nov 19;8(1):805-810. doi: 10.2176/nmccrj.cr.2021-0150. eCollection 2021.
An accessory middle cerebral artery (AMCA) is a variant vessel that branches from the anterior cerebral artery (ACA) and runs through the Sylvian fissure along the middle cerebral artery (MCA). We report a case of acute embolic occlusion of the AMCA that was treated with thrombectomy using direct aspiration first pass technique (ADAPT). An 88-year-old woman with a history of atrial fibrillation, loss of consciousness, and right hemiparesis was referred to our hospital. Diffusion-weighted magnetic resonance imaging (MRI) showed high signal intensity in the left frontal lobe, insular cortex, and deep white matter, and magnetic resonance angiography (MRA) demonstrated left internal carotid artery (ICA) occlusion. Mechanical thrombectomy using the ADAPT technique was performed with complete recanalization. Final angiography revealed left ACA and AMCA because of the thrombus located at the origin of the left ACA and AMCA. In the case of an acute ischemic stroke associated with AMCA, it is difficult to understand and recognize the anatomy of the vessel before thrombectomy. Therefore, the ADAPT technique, which can treat acute embolic occlusion without lesion passing, is recommended due to its safety. If there is a mismatch between the perfusion area of the occluded artery and the ischemic area or the neurological findings before thrombectomy, it is extremely important to keep in mind the presence of vessel variation in the MCA.
大脑中副动脉（AMCA）是一种变异血管，它从大脑前动脉（ACA）分支出来，沿着大脑中动脉（MCA）穿过外侧裂。我们报告一例大脑中副动脉急性栓塞闭塞病例，采用直接抽吸首次通过技术（ADAPT）进行血栓切除术治疗。一名88岁有房颤病史、意识丧失和右侧偏瘫的女性被转诊至我院。弥散加权磁共振成像（MRI）显示左侧额叶、岛叶皮质和深部白质高信号，磁共振血管造影（MRA）显示左侧颈内动脉（ICA）闭塞。采用ADAPT技术进行机械血栓切除术，实现了完全再通。最终血管造影显示左侧大脑前动脉和大脑中副动脉，因为血栓位于左侧大脑前动脉和大脑中副动脉的起始处。对于与大脑中副动脉相关的急性缺血性卒中，在血栓切除术之前很难理解和识别该血管的解剖结构。因此，由于其安全性，推荐使用可在不通过病变的情况下治疗急性栓塞闭塞的ADAPT技术。如果在血栓切除术之前闭塞动脉的灌注区域与缺血区域或神经学表现之间存在不匹配，牢记大脑中动脉存在血管变异极为重要。
