Sasaki Isao, Imahori Taichiro, Yano Tatsuya, Onobuchi Kana, 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 Oct 31;18(1):150-155. doi: 10.1016/j.radcr.2022.10.017. eCollection 2023 Jan.
Intracranial artery dissection is an uncommon but possible cause of ischemic stroke, and is usually diagnosed based on imaging findings such as mural hematoma and dissection flap. However, it is challenging to recognize the underlying dissection in cases of acute large vessel occlusion. In this report, we present a case of acute internal carotid artery occlusion, in which the underlying dissection of the paraclinoid segment was found during the thrombectomy procedure. Two thrombectomy procedures failed to recanalize the acute internal carotid artery occlusion without removing any clot. Angiography performed during a Trevo stent retriever deployment in the first pass showed obscure contrast defects in the stent strut with temporary flow restoration. In the next pass, the appearance of the contrast defects changed and a parallel linear contrast appeared on the outside of the vessel wall. These angiographic findings were identified as mural hematoma and dissection flap, indicating dissection of the paraclinoid as the cause of the occlusion. During antiplatelet loading and preparation of a dedicated intracranial stent, the Trevo stent retriever was left deployed again at the occlusion site to maintain the blood flow. After permanent stenting with an Enterprise stent, angiography revealed complete recanalization. The patient recovered fully after the procedure. In the present case, stent retriever deployment revealed the hallmarks of dissection on angiography, such as mural hematoma, dissection flap, and temporal morphological changes, by restoring the blood flow temporarily. Such angiographic findings can provide useful information on the occlusion characteristics and real-time feedback for optimal treatment strategy.
颅内动脉夹层是缺血性卒中一种少见但可能的病因，通常根据壁内血肿和夹层瓣等影像学表现来诊断。然而，在急性大血管闭塞的病例中识别潜在的夹层具有挑战性。在本报告中，我们呈现了1例急性颈内动脉闭塞病例，在血栓切除术过程中发现了床突旁段的潜在夹层。两次血栓切除术均未能使急性颈内动脉闭塞再通，且未取出任何血栓。在首次通过Trevo取栓支架时进行的血管造影显示支架支柱内造影剂充盈缺损模糊，血流暂时恢复。在下一次通过时，造影剂充盈缺损的表现发生了变化，血管壁外侧出现了平行的线性造影剂。这些血管造影表现被确定为壁内血肿和夹层瓣，提示床突旁夹层是闭塞的原因。在进行抗血小板负荷和准备专用颅内支架期间，Trevo取栓支架再次留在闭塞部位以维持血流。在用Enterprise支架进行永久性支架置入后，血管造影显示完全再通。术后患者完全康复。在本病例中，取栓支架的置入通过暂时恢复血流，在血管造影上显示出夹层的特征，如壁内血肿､夹层瓣和短暂的形态变化。这些血管造影表现可为闭塞特征提供有用信息，并为优化治疗策略提供实时反馈。
