Yajima Hirohisa, Koizumi Satoshi, Miyawaki Satoru, Saito Nobuhito
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Front Neurol. 2022 Feb 7;13:828245. doi: 10.3389/fneur.2022.828245. eCollection 2022.
The treatment for middle cerebral artery subocclusive thrombi is not standardized. Here, we report a case of M1 subocclusive thrombus with lateral lenticulostriate artery occlusion that was successfully treated with mechanical thrombectomy. This article describes a treatment strategy for M1 subocclusive thrombus, focusing on the indications for mechanical thrombectomy. A 58-year-old male on admission for pneumonia had a sudden onset of dysarthria and motor deficits. He has a history of dilated cardiomyopathy and underwent left ventricular assist device implantation 3 years ago. At onset, his National Institutes of Health Stroke Scale (NIHSS) score was nine. Computed tomography angiography demonstrated a filling defect in the distal right M1 segment of the middle cerebral artery. Angiography confirmed the presence of a subocclusive thrombus within the distal right M1 segment, although peripheral blood flow was maintained. Mechanical thrombectomy was performed for the M1 subocclusive thrombus using a direct aspiration first-pass technique, resulting in successful aspiration of the thrombus on the first pass. After the procedure, recanalization of the lateral lenticulostriate artery was detected, and the patient demonstrated full recovery (NIHSS score 0). Mechanical thrombectomy can be considered as a treatment option in cases of acute ischemic stroke caused by M1 subocclusive thrombus with lateral lenticulostriate artery occlusion, which presents with a high NIHSS score or neurological deterioration.
大脑中动脉亚闭塞性血栓的治疗方法尚未标准化。在此，我们报告一例M1段亚闭塞性血栓合并外侧豆纹动脉闭塞的病例，该病例通过机械取栓术成功治疗。本文描述了一种针对M1段亚闭塞性血栓的治疗策略，重点关注机械取栓的适应证。一名因肺炎入院的58岁男性突然出现构音障碍和运动功能缺损。他有扩张型心肌病病史，3年前接受了左心室辅助装置植入术。发病时，他的美国国立卫生研究院卒中量表（NIHSS）评分为9分。计算机断层血管造影显示大脑中动脉右侧M1段远端有充盈缺损。血管造影证实右侧M1段远端存在亚闭塞性血栓，尽管外周血流得以维持。采用直接抽吸首次通过技术对M1段亚闭塞性血栓进行机械取栓，首次通过即成功抽吸出血栓。术后，检测到外侧豆纹动脉再通，患者完全康复（NIHSS评分0分）。对于由M1段亚闭塞性血栓合并外侧豆纹动脉闭塞引起的急性缺血性卒中，若NIHSS评分高或出现神经功能恶化，可考虑将机械取栓作为一种治疗选择。
