Yi Tingyu, Chen Wenhuo, Wu Yanmin, Pan Zhinan, Lin Xiaohui, Lin Dinglai, Chen Rongcheng, Zheng Xiufeng
Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China.
Brain Sci. 2022 Jun 10;12(6):760. doi: 10.3390/brainsci12060760.
Vessel perforation during stent mechanical thrombectomy (MT) is a rare and disastrous complication. A routine rescue strategy includes balloon occlusion for tamponade, procedure suspension, and lowering or normalizing blood pressure. However, this complication is still associated with poor outcome and high mortality.
We present our experience with intra-arterial injection of thrombin in the treatment of vessel perforation secondary to microcatheter/microwire perforation, which prevents further deterioration in clinical outcomes.
Cases with intraprocedural vessel perforation during mechanical thrombectomy were included in the final analysis. Clinical data, procedural details, and radiographic and clinical outcomes were collected.
Four patients with intraprocedural vessel perforation were included. Intraprocedural perforations occurred at the distal middle cerebral artery in two cases: the A2 segment in one case and the internal carotid artery terminus in one case. The etiology of four cases was intracranial atherosclerotic stenosis (ICAS). The ruptured vessels were effectively occluded in all cases. Endovascular therapy was continued in three cases, and mTICI ≥ 2b recanalization was achieved in all cases. The culprit artery was kept patent on CTA for 72 h post-operation. No active bleeding was detected on follow-up CT post-operation. During the 90-day follow-up period, one patient died, modified Rankle Scare (mRS) 3 was observed in two patients, and mRS 4 was observed in one patient.
The key benefit of this method is occluding the ruptured vessel without affecting the following MT. We propose that intra-arterial injection of prothrombin may be simple yet effective in managing vessel perforation complications during MT.
支架机械取栓术（MT）期间血管穿孔是一种罕见且灾难性的并发症。常规的挽救策略包括用球囊封堵进行压迫止血、暂停手术以及降低血压或使血压正常化。然而，这种并发症仍然与不良预后和高死亡率相关。
我们介绍动脉内注射凝血酶治疗微导管/微导丝穿孔继发的血管穿孔的经验，该方法可防止临床结局进一步恶化。
最终分析纳入了机械取栓术中发生术中血管穿孔的病例。收集临床数据、手术细节以及影像学和临床结局。
纳入4例术中血管穿孔患者。术中穿孔发生在大脑中动脉远端2例：1例为A2段，1例为颈内动脉末端。4例的病因均为颅内动脉粥样硬化狭窄（ICAS）。所有病例中破裂血管均被有效封堵。3例继续进行血管内治疗，所有病例均实现mTICI≥2b级再通。术后CTA显示责任动脉在术后72小时保持通畅。术后随访CT未发现活动性出血。在90天随访期内，1例患者死亡，2例患者改良Rankin量表（mRS）评分为3分，1例患者mRS评分为4分。
该方法的关键益处在于封堵破裂血管而不影响后续的MT。我们认为动脉内注射凝血酶在处理MT期间的血管穿孔并发症方面可能简单而有效。
