机械取栓过程中微导管主体致颈内动脉穿孔引起的直接颈内动脉海绵窦瘘

Miyamoto Satoshi, Kato Noriyuki, Yamazaki Tomosato, Yamano Akinari, Akutsu Yoshimitsu, Yasuda Susumu, Matsumaru Yuji, Ishikawa Eiichi

Department of Neurosurgery, Mito Medical Center, Mito, Ibaraki, Japan.

Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.

Asian J Neurosurg. 2022 Oct 19;17(4):638-641. doi: 10.1055/s-0042-1757629. eCollection 2022 Dec.

Rapid advances in emergent mechanical thrombectomy have resulted in a higher occurrence of arterial perforations during neurointerventions. Here, we report a case of internal carotid artery (ICA) perforation during mechanical thrombectomy in a 78-year-old man with a left middle cerebral artery occlusion. The ICA was perforated by a microcatheter during thrombectomy, forming a direct carotid-cavernous fistula. A two-stage drainer occlusion was conducted because of cortical venous reflex aggravation and ocular symptoms. Here, we report the perforation details and treatment, adding to evidence that ICA perforation with the microcatheter body is a concern during mechanical thrombectomy.

急诊机械取栓术的迅速发展导致神经介入过程中动脉穿孔的发生率更高。在此，我们报告一例78岁男性左大脑中动脉闭塞患者在机械取栓过程中发生颈内动脉（ICA）穿孔的病例。取栓过程中微导管穿破ICA，形成直接的颈内动脉海绵窦瘘。由于皮质静脉回流加重和眼部症状，进行了两阶段的引流器闭塞治疗。在此，我们报告穿孔细节及治疗情况，进一步证明在机械取栓过程中微导管主体导致的ICA穿孔是一个需要关注的问题。