Tamura Takamitsu, Ota Nakao, Okada Yasuaki, Valenzuela Johan, Noda Kosumo, Kamiyama Hiroyasu, Tanikawa Rokuya
Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
Hospital Ana Francisca Perez de Leon II, Caracas, Venezuela.
J Neuroendovasc Ther. 2021;15(2):94-99. doi: 10.5797/jnet.cr.2020-0105. Epub 2020 Sep 8.
We describe an instructive case of post-thrombectomy subarachnoid hemorrhage (PTSAH) by sylvian hematoma removal.
An 83-year-old female presented with an acute cardiogenic right M1 occlusion. After the thrombectomy with combined stent retriever and aspiration technique with total five passes, TICI 2b reperfusion was achieved; however, CT imaging displayed subarachnoid hematoma (SAH) along the right sylvian fissure. Throughout the approach, contrast extravasation was not confirmed. The SAH grew up to become the sylvian hematoma; therefore, removal of the sylvian hematoma was conducted. An abrupt arteriole tear around the distal M2 of parietal artery was confirmed as bleeding point and those teared arteriole's stumps were electrically coagulated not to re-bleed.
We suggest that the PTSAH is possible even in invisible-extravasation cases and the sylvian hematoma removal is effective to elucidate the etiology of the PTSAH, and is a reliable method to prevent the re-bleeding and is anticipated to improve the prognosis. Craniotomy is required for medically resistant PTSAH after thrombectomy, and avulsion of the pial artery can be the cause.
我们描述一例通过外侧裂血肿清除术治疗的血栓切除术后蛛网膜下腔出血（PTSAH）的典型病例。
一名83岁女性因急性心源性右大脑中动脉M1段闭塞就诊。采用联合支架取栓器和抽吸技术进行血栓切除术，共进行了五次操作，实现了TICI 2b级再灌注；然而，CT成像显示右侧外侧裂有蛛网膜下腔血肿（SAH）。在整个手术过程中，未证实有造影剂外渗。SAH逐渐发展为外侧裂血肿；因此，进行了外侧裂血肿清除术。确认顶叶动脉远端M2周围的一条小动脉突然撕裂为出血点，对撕裂的小动脉残端进行电凝以防止再次出血。
我们认为，即使在无造影剂外渗的情况下，PTSAH也有可能发生，外侧裂血肿清除术有助于明确PTSAH的病因，是预防再次出血的可靠方法，有望改善预后。血栓切除术后对内科治疗无效的PTSAH需要开颅手术，软脑膜动脉撕裂可能是其病因。
