Lai Tian-Min, Lin Kun-Xin, Fu Ying, Fang Ling, Zhao Wen-Long
J Neurosurg Case Lessons. 2023 May 15;5(20). doi: 10.3171/CASE22404.
Mechanical thrombectomy (MT) has been proved to be a highly effective therapy to treat acute ischemic stroke due to large vessel occlusion. Often, the ischemic core extent on baseline imaging is an important determinant for endovascular treatment eligibility. However, computed tomography (CT) perfusion (CTP) or diffusion-weighted imaging may overestimate the infarct core on admission and, consequently, smaller infarct lesions called "ghost infarct cores."
A 4-year-old, previously healthy boy presented with acute-onset, right-sided weakness and aphasia. Fourteen hours after the onset of symptoms, the patient presented with a National Institutes of Health Stroke Scale (NIHSS) score of 22, and magnetic resonance angiography demonstrated a left middle cerebral artery occlusion. MT was not considered because of a large infarct core (infarct core volume: 52 mL; mismatch ratio 1.6 on CTP). However, multiphase CT angiography indicated good collateral circulation, which encouraged MT. Complete recanalization was achieved via MT at 16 hours after the onset of symptoms. The child's hemiparesis improved. Follow-up magnetic resonance imaging was nearly normal and showed that the baseline infarct lesion was reversible, in agreement with neurological improvement (NIHSS score 1).
The selection of pediatric stroke with a delayed time window guided by good collateral circulation at baseline seems safe and efficacious, which suggests a promising value of vascular window.
机械取栓术（MT）已被证明是治疗大血管闭塞所致急性缺血性卒中的一种高效疗法。通常，基线影像学检查时的缺血核心范围是血管内治疗适应证的重要决定因素。然而，计算机断层扫描（CT）灌注成像（CTP）或扩散加权成像可能会高估入院时的梗死核心，进而出现较小的梗死灶，即所谓的“假性梗死核心”。
一名4岁、既往健康的男孩出现急性起病的右侧肢体无力和失语。症状发作14小时后，患者美国国立卫生研究院卒中量表（NIHSS）评分为22分，磁共振血管造影显示左侧大脑中动脉闭塞。由于梗死核心较大（梗死核心体积：52 mL；CTP上的不匹配率为1.6），未考虑进行MT治疗。然而，多期CT血管造影显示侧支循环良好，这促使进行MT治疗。症状发作16小时后通过MT实现了完全再通。患儿的偏瘫症状有所改善。随访磁共振成像几乎正常，显示基线梗死灶可逆，与神经功能改善情况相符（NIHSS评分1分）。
以基线良好侧支循环为指导，选择时间窗延迟的儿童卒中进行治疗似乎安全有效，这表明血管窗具有潜在价值。
