Department of Neurology, Liaocheng People's Hospital, NO. 67, West Dongchang Road, Shandong, Liaocheng City, 252000, China.
Department of Traditional Chinese Medicine, Liaocheng Third People's Hospital, No.62, Weiyu Road, Shandong, Liaocheng City, 252000, China.
BMC Neurol. 2023 Mar 24;23(1):119. doi: 10.1186/s12883-023-03173-y.
Acute bilateral occlusion of the middle cerebral artery (MCA) is a very rare condition, and most cases are accompanied by a poor prognosis. However, mechanical thrombectomy (MT) for bilateral MCA is challenging. Here, we report a case of acute unilateral MCA occlusion with sequential acute occlusion of the bilateral MCA during intravenous thrombolysis (IVT). We urgently performed bilateral MT of the MCA and effective recanalization.
The patient is a 73-year-old man who complained of a sudden adverse influence on speech and an inability to move his left limb for 2 h. He had a history of paroxysmal atrial fibrillation, but had never used any anticoagulants before. Head and neck computed tomography angiography (CTA) showed embolism in the right M1 MCA. During intravenous alteplase thrombolytic therapy, the patient suddenly became unconscious. Cerebral angiography showed occlusion of the M1 segment of the bilateral MCA in the patients. MT of the bilateral MCA was performed using a combination of a stent retriever and an aspiration catheter with mTici 3 revascularization. On the second day, the patient became conscious, although he had remaining symptoms of speech insufficiency and weakness of the left limb. The mRS score was 2 90 days after the operation.
Acute bilateral occlusion of the M1 segment of the MCA is extremely rare and is accompanied by high morbidity and high mortality. Intravenous alteplase thrombolysis can increase the risk of atrial thrombus shedding in patients with atrial fibrillation, so patients with acute bilateral MCA occlusion in the M1 segment chose direct MT or bridging therapy, which remains controversial, and the sequence of MT remains to be discussed. Nevertheless, early endovascular treatment can decrease the morbidity and mortality of such patients.
急性大脑中动脉（MCA）双侧闭塞是一种非常罕见的情况，大多数病例预后较差。然而，双侧 MCA 的机械血栓切除术（MT）具有挑战性。在此，我们报告一例急性单侧 MCA 闭塞，在静脉溶栓（IVT）过程中相继发生双侧 MCA 急性闭塞。我们紧急对双侧 MCA 进行 MT 治疗，实现了有效的再通。
患者为 73 岁男性，突发言语不利伴左侧肢体无力 2 h 就诊。既往阵发性心房颤动病史，但未使用任何抗凝药物。头颈部 CT 血管造影（CTA）显示右侧 M1 MCA 栓塞。在静脉注射阿替普酶溶栓治疗过程中，患者突然意识丧失。脑血管造影显示双侧 MCA M1 段闭塞。采用支架取栓器联合抽吸导管进行双侧 MCA MT，达到 mTICI 3 级再通。第 2 天，患者意识恢复，但仍遗留言语不利和左侧肢体无力症状。术后 90 天 mRS 评分为 2 分。
急性 MCA M1 段双侧闭塞极为罕见，发病率和死亡率均较高。静脉注射阿替普酶溶栓可能增加房颤患者心房血栓脱落的风险，因此急性 MCA M1 段双侧闭塞的患者选择直接 MT 或桥接治疗存在争议，序贯 MT 也仍存在争议。然而，早期血管内治疗可降低此类患者的发病率和死亡率。
