Sasaki Isao, Imahori Taichiro, Yano Tatsuya, Gomi Masanori, Kuroda Junko, Kobayashi Norikata, Sato Kimitoshi, Niwa Yoji, IwasaKi Koichi, Hasegawa Hiroshi
Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan.
Radiol Case Rep. 2022 Apr 4;17(6):1848-1852. doi: 10.1016/j.radcr.2022.03.023. eCollection 2022 Jun.
Mechanical thrombectomy is highly effective for the recovery of acute ischemic stroke with large vessel occlusion. However, refractory occlusions are still encountered despite the use of currently available devices. In this article, we present a case of refractory terminal internal carotid artery occlusion treated with the "crossing double stent retriever technique." Two thrombectomy procedures with the combined technique using a stent retriever and aspiration catheter failed to recanalize the terminal internal carotid artery occlusion that involved the dominant anterior cerebral artery. We then applied the crossing double stent retriever technique as a rescue technique. Two microcatheters were advanced across the occlusion: one to the anterior cerebral artery and the other to the middle cerebral artery. First, a Trevo NXT 4 mm stent retriever was deployed from the anterior cerebral artery. Next, an additional Trevo NXT 4 mm stent retriever was deployed from the middle cerebral artery, and full immediate restoration of flow was achieved on angiography. Intraprocedural radiological images showed that the 2 microcatheters traversed different pathways, and the 2 stent retrievers completely covered the entire vessel with apparent in-stent clot sign. Both stent retrievers were then pulled back together, and a hard clot was retrieved. Subsequent angiography revealed complete recanalization. The crossing double stent retriever technique seems an effective rescue technique for treating refractory terminal internal carotid artery occlusion, especially with the anatomical feature of branching of the dominant anterior cerebral artery. This technique can facilitate the device-clot-vessel interaction by engaging the clot via 2 different device pathways.
机械取栓术对大血管闭塞性急性缺血性卒中的恢复非常有效。然而，尽管使用了现有的设备，仍会遇到难治性闭塞。在本文中，我们介绍了一例采用“交叉双支架取栓技术”治疗的难治性颈内动脉末端闭塞病例。使用支架取栓器和抽吸导管联合技术进行的两次取栓手术未能使累及优势大脑前动脉的颈内动脉末端闭塞再通。然后，我们应用交叉双支架取栓技术作为挽救技术。将两根微导管穿过闭塞部位：一根进入大脑前动脉，另一根进入大脑中动脉。首先，从大脑前动脉部署一个4mm的Trevo NXT支架取栓器。接下来，从大脑中动脉再部署一个4mm的Trevo NXT支架取栓器，血管造影显示血流立即完全恢复。术中放射影像显示两根微导管穿过不同路径，两个支架取栓器完全覆盖整个血管，有明显的支架内血栓迹象。然后将两个支架取栓器一起回撤，取出一个硬血栓。随后的血管造影显示完全再通。交叉双支架取栓技术似乎是治疗难治性颈内动脉末端闭塞的一种有效挽救技术，特别是对于具有优势大脑前动脉分支解剖特征的情况。该技术可通过两条不同的器械路径与血栓结合，促进器械 - 血栓 - 血管的相互作用。
