Shim Dong-Hyun, Do Youngrok, Do Jin Kuk, Youn Sung Won
Department of Neurology, Daegu Catholic University Medical Center, Daegu, Korea.
Department of Radiology, Daegu Catholic University Medical Center, Daegu, Korea.
Neurointervention. 2022 Jul;17(2):121-125. doi: 10.5469/neuroint.2022.00101. Epub 2022 May 10.
We report a case of delayed rupture of an anterior communicating artery (Acom) pseudoaneurysm following mechanical thrombectomy (MT) of a distal artery occlusion using a stent retriever. An elderly patient with right hemiparesis showed left proximal internal cerebral artery and middle cerebral artery occlusions. During MT, a fragmented thrombus moved to the anterior cerebral artery (ACA). A stent retriever was deployed to the occluded ACA, and the Acom and proximal ACA segment were significantly straightened. Additionally, we attempted a blind exchange mini-pinning (BEMP) technique, but a subarachnoid hemorrhage (SAH) occurred. Bleeding was almost entirely absorbed 9 days after the procedure, but the SAH recurred at 20 days, and computed tomography angiography revealed a new pseudoaneurysm formation in the Acom. We suggest that the proposed mechanism of pseudoaneurysm formation was likely due to the dislocation and avulsion of the Acom perforators when the ipsilateral ACA was pushed and pulled during MT.
我们报告了一例使用支架取栓器对远端动脉闭塞进行机械取栓术后前交通动脉（Acom）假性动脉瘤延迟破裂的病例。一名患有右侧偏瘫的老年患者显示左侧大脑前动脉近端和大脑中动脉闭塞。在机械取栓过程中，一个破碎的血栓移动到了大脑前动脉（ACA）。将一个支架取栓器部署到闭塞的ACA处，Acom和ACA近端节段明显变直。此外，我们尝试了盲式交换微型固定（BEMP）技术，但发生了蛛网膜下腔出血（SAH）。术后9天出血几乎完全吸收，但SAH在20天时复发，计算机断层血管造影显示Acom处有新的假性动脉瘤形成。我们认为，假性动脉瘤形成的推测机制可能是在机械取栓过程中同侧ACA被推拉时Acom穿支的移位和撕裂所致。
