Fujiwara Hidemoto, Tsuchiya Naoto, Saito Taiki, Ohkura Ryota, Yoshimura Junichi
Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan.
J Neuroendovasc Ther. 2022;16(5):270-276. doi: 10.5797/jnet.cr.2021-0040. Epub 2021 Sep 16.
We report a patient with acute bihemispheric infarction who underwent mechanical thrombectomy.
A 76-year-old man suddenly developed coma and quadriplegia. Brain MRI and MRA revealed acute bihemispheric infarction due to occlusions of both the internal carotid arteries (ICAs). According to the DSA findings, we considered the left ICA as chronic occlusion and the right as acute. Mechanical thrombectomy for the right ICA occlusion was performed. Total recanalization was achieved using a stent retriever 181 minutes after onset. The left hemisphere was perfused by cross circulation through the anterior communicating artery, but the symptoms did not improve. MRI the day after thrombectomy showed extensive bihemispheric infarction. Recanalization for the bilateral hemispheres was maintained, although the left ICA remained occluded. He died 2 months later due to gastrointestinal bleeding.
Acute bihemispheric infarction due to occlusions of both ICAs is a rare entity. The symptoms are very severe and the therapeutic time window is extremely short because of absent collateral pathways. We should consider pre-existing carotid occlusive disease, determine whether the occlusions are acute or chronic, and perform prompt therapy. Further investigation is warranted to obtain a better outcome.
我们报告一例接受机械取栓术的急性双侧大脑半球梗死患者。
一名76岁男性突然出现昏迷和四肢瘫痪。脑部MRI和MRA显示双侧颈内动脉闭塞导致急性双侧大脑半球梗死。根据DSA检查结果，我们认为左侧颈内动脉为慢性闭塞，右侧为急性闭塞。对右侧颈内动脉闭塞进行了机械取栓术。发病181分钟后使用支架取栓器实现了完全再通。左侧半球通过前交通动脉的交叉循环获得灌注，但症状并未改善。取栓术后第二天的MRI显示广泛的双侧大脑半球梗死。尽管左侧颈内动脉仍闭塞，但双侧半球的再通得以维持。他在2个月后因消化道出血死亡。
双侧颈内动脉闭塞所致急性双侧大脑半球梗死是一种罕见疾病。由于缺乏侧支循环途径，症状非常严重，治疗时间窗极短。我们应考虑既往存在的颈动脉闭塞性疾病，确定闭塞是急性还是慢性，并进行及时治疗。有必要进一步研究以获得更好的结果。
