Tomoyose Ryuta, Tsumoto Tomoyuki, Hara Kenta, Miyazaki Yuichi, Tokunaga So, Yasaka Masahiro, Okada Yasushi
Departments of Neuroendovascular Surgery and.
Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
J Neurosurg Case Lessons. 2021 Aug 30;2(9):CASE21338. doi: 10.3171/CASE21338.
The authors report a case in which mechanical thrombectomy and carotid artery stenting (CAS) were performed for acute cerebral infarction with free-floating thrombosis (FFT) in left internal carotid artery (ICA) stenosis. Good results were obtained.
A 63-year-old man developed sudden disturbance of consciousness and right hemiplegia. He was transported to the authors' hospital by an emergency vehicle. Head magnetic resonance imaging showed acute cerebral infarction in the left middle cerebral artery region, and magnetic resonance angiography showed poor vascular flow beyond the left ICA. Emergency angiography revealed severe stenosis at the origin of the left ICA and a free-floating thrombus attached to the stenosis and extending to the peripheral side. Percutaneous transluminal angioplasty (PTA) was performed on the stenosis with proximal protection, the thrombus was aspirated under reversal flow, and CAS was performed without exacerbation of clinical symptoms.
PTA, thrombus aspiration, and CAS under reversal flow may be effective treatments for FFT caused by ICA stenosis.
作者报告了一例对左颈内动脉（ICA）狭窄合并游离血栓（FFT）的急性脑梗死患者进行机械取栓和颈动脉支架置入术（CAS）的病例，并取得了良好效果。
一名63岁男性突发意识障碍和右侧偏瘫，由急救车送至作者所在医院。头部磁共振成像显示左侧大脑中动脉区域急性脑梗死，磁共振血管造影显示左颈内动脉远端血流不佳。急诊血管造影显示左颈内动脉起始处严重狭窄，有一个游离血栓附着于狭窄处并延伸至外周。对狭窄处进行了近端保护下的经皮腔内血管成形术（PTA），在逆向血流下抽吸血栓，且在未加重临床症状的情况下进行了CAS。
PTA、血栓抽吸和逆向血流下的CAS可能是治疗ICA狭窄所致FFT的有效方法。
