Dofuku Shogo, Sato Masayuki, Aoka Takashi, Nakamura Rika, Ohara Kenta, Ota Takahiro
Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
NMC Case Rep J. 2023 Jun 26;10:191-195. doi: 10.2176/jns-nmc.2022-0366. eCollection 2023.
We report a rare case of isolated internal carotid artery occlusion complicated by central retinal artery occlusion that was successfully treated with mechanical thrombectomy for internal carotid artery occlusion. A 59-year-old man visited the emergency room because of right monocular blindness. Magnetic resonance imaging showed multiple acute small embolic infarctions in the right frontal lobe, and magnetic resonance angiography revealed right internal carotid artery occlusion without the associated occlusion of the circle of Willis, which indicates the patency of the anterior and middle cerebral arteries. An electrocardiogram showed atrial fibrillation. Therefore, we performed mechanical thrombectomy with a stent retriever under continuous manual aspiration with a balloon-guiding catheter and confirmed complete recanalization, anterograde flow in the right ophthalmic artery, and retinal brush. The procedure was completed without complications, and the patient noticed an improvement in visual acuity immediately after the procedure. When a patient with atrial fibrillation complains of monocular blindness, it is important to consider internal carotid artery occlusion due to cardioembolism, to perform an examination promptly, and to consider early treatment, including mechanical thrombectomy.
我们报告了一例罕见的孤立性颈内动脉闭塞合并视网膜中央动脉闭塞的病例，该病例通过对颈内动脉闭塞进行机械取栓术而成功治愈。一名59岁男性因右眼单眼失明就诊于急诊室。磁共振成像显示右侧额叶有多个急性小栓塞性梗死灶，磁共振血管造影显示右侧颈内动脉闭塞，而Willis环未出现相关闭塞，这表明大脑前动脉和大脑中动脉通畅。心电图显示心房颤动。因此，我们使用支架取栓器在球囊引导导管持续手动抽吸下进行了机械取栓术，并确认完全再通、右眼动脉顺行血流以及视网膜灌注良好。手术过程顺利，无并发症发生，患者术后视力立即有所改善。当房颤患者出现单眼失明时，重要的是要考虑心源性栓塞导致的颈内动脉闭塞，及时进行检查，并考虑包括机械取栓术在内的早期治疗。
