Matsubara Noriaki, Fukuo Yusuke, Yoshimura Kohei, Kashiwagi Hideki, Futamura Gen, Park Yangtae, Kuroiwa Toshihiko, Wanibuchi Masahiko
Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan.
Department of Neurosurgery, Tesseikai Neurosurgical Hospital, Shijonawate, Osaka, Japan.
J Neuroendovasc Ther. 2021;15(6):366-372. doi: 10.5797/jnet.cr.2020-0101. Epub 2021 Jan 20.
We report a case of the marked growth and rupture of a giant femoral artery pseudoaneurysm at the puncture site that developed after recanalization therapy for acute basilar artery occlusion.
A 79-year-old woman developed acute ischemic stroke due to atherosclerotic basilar artery occlusion. Endovascular intervention was performed and recanalization of the affected vessel was achieved. However, she developed brainstem infarction and consciousness disturbance persisted. The femoral access site was treated using a vascular closure device at the end of the procedure. A right femoral artery pseudoaneurysm of approximately 5 cm in size was found 2 weeks after onset during the examination for deep venous thrombosis with right lower extremity edema. Manual compression did not achieve thrombotic occlusion of the aneurysm due to obesity and leg edema. Considering the severe neurological status of the patient, the pseudoaneurysm was followed up without surgical treatment. Dual antiplatelet therapy and direct oral anticoagulant agents were administered. Four weeks after onset, the pseudoaneurysm presented rapid growth, and on the 35th day after onset, it exceeded 15 cm in size and ruptured, causing hemorrhagic shock with massive femoral hematoma. Pseudoaneurysm resection and hematoma removal were performed surgically, and the patient recovered. However, improvement of neurological manifestations was poor and the modified Rankin Scale at 90 days after onset was 5.
A case of giant femoral artery pseudoaneurysm following recanalization therapy for acute ischemic stroke was reported. Pseudoaneurysms at the puncture site can rupture after significant growth. Curative treatment is required without delay.
我们报告一例急性基底动脉闭塞再通治疗后穿刺部位巨大股动脉假性动脉瘤显著生长并破裂的病例。
一名79岁女性因动脉粥样硬化性基底动脉闭塞发生急性缺血性卒中。进行了血管内介入治疗，受累血管实现再通。然而，她发生了脑干梗死，意识障碍持续存在。手术结束时使用血管闭合装置处理了股动脉穿刺部位。在对右下肢水肿进行深静脉血栓形成检查时，发病2周后发现一个大小约5厘米的右股动脉假性动脉瘤。由于肥胖和腿部水肿，手动压迫未能使动脉瘤血栓形成闭塞。考虑到患者严重的神经状态，对假性动脉瘤进行了随访，未进行手术治疗。给予双联抗血小板治疗和直接口服抗凝剂。发病4周后，假性动脉瘤迅速生长，在发病第35天时，其大小超过15厘米并破裂，导致出血性休克和大量股部血肿。通过手术进行了假性动脉瘤切除和血肿清除，患者康复。然而，神经功能表现改善不佳，发病90天后改良Rankin量表评分为5分。
报告了一例急性缺血性卒中再通治疗后发生巨大股动脉假性动脉瘤的病例。穿刺部位的假性动脉瘤在显著生长后可能破裂。需要及时进行根治性治疗。
