Shibata Aoto, Yanagawa Taro, Sugasawa Shin, Ikeda Shunsuke, Ikeda Toshiki
Stroke Center, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midoriku, Sagamihara, Kanagawa, 252-5188, Japan.
Radiol Case Rep. 2023 Jun 30;18(9):3206-3211. doi: 10.1016/j.radcr.2023.06.024. eCollection 2023 Sep.
Mechanical thrombectomy (MT) is a highly effective treatment for acute ischemic stroke, and hemorrhagic complications caused by vessel injury are rare. However, there is no evidence regarding the efficacy of MT for multiple large vessel occlusion or its procedural strategy. Herein, we report a case of MT with a stent retriever for multiple large vessel occlusion in the internal carotid artery and middle cerebral artery M1 distal, which resulted in vessel perforation in a single pass. A 79-year-old woman underwent MT for internal carotid artery occlusion, and multiple large vessel occlusion was observed on digital subtraction angiography. A longer and larger stent retriever was selected for thrombus retrieval in a single pass. Immediately after retrieval, digital subtraction angiography revealed internal carotid artery recanalization. Then, extravasation was observed from the M1 distal occlusion. Treatment was interrupted after hemostasis was confirmed. Nevertheless, rebleeding occurred after 4 hours. Emergency trapping was performed, and vessel perforation of >1 mm was observed. When retrieving a thrombus in a single pass with a stent retriever for multiple large vessel occlusion, vessel perforation may occur if the device is selected according to the diameter of the proximal occluded vessel. Based on the type of device, even a single pass may result in vessel perforation. Although aggressive MT intervention should be performed for multiple large vessel occlusion, a device that is appropriate for the pathological condition must be selected.
机械取栓术（MT）是治疗急性缺血性卒中的一种高效方法，由血管损伤引起的出血性并发症较为罕见。然而，目前尚无关于MT治疗多支大血管闭塞的疗效及其操作策略的证据。在此，我们报告一例使用支架取栓器对颈内动脉和大脑中动脉M1段远端多支大血管闭塞进行MT治疗的病例，该操作单次通过导致血管穿孔。一名79岁女性因颈内动脉闭塞接受MT治疗，数字减影血管造影显示多支大血管闭塞。选择了更长、更大的支架取栓器进行单次血栓取出。取出后立即进行数字减影血管造影显示颈内动脉再通。随后，在M1段远端闭塞处观察到造影剂外渗。确认止血后中断治疗。然而，4小时后再次出血。进行了急诊血管封堵，观察到血管穿孔大于1毫米。当使用支架取栓器单次通过取出多支大血管闭塞处的血栓时，如果根据近端闭塞血管的直径选择器械，可能会发生血管穿孔。根据器械类型，即使单次通过也可能导致血管穿孔。尽管对于多支大血管闭塞应积极进行MT干预，但必须选择适合病情的器械。
