Sogabe Shu, Kanematsu Yasuhisa, Miyamoto Takeshi, Yamaguchi Izumi, Yamamoto Yuki, Yamaguchi Tadashi, Yamamoto Nobuaki, Shimada Kenji, Takagi Yasushi
Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan.
Department of Clinical Neurosciences, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan.
J Neuroendovasc Ther. 2021;15(1):38-45. doi: 10.5797/jnet.cr.2020-0015. Epub 2020 Aug 28.
We report a case of acute internal carotid artery occlusion in a patient with adult-onset moyamoya disease who underwent mechanical thrombectomy and had a good outcome.
A 73-year-old woman was diagnosed with moyamoya disease by asymptomatic right middle cerebral artery occlusion at 59 years of age. The patient was transported for stroke symptoms. Magnetic resonance imaging (MRI) demonstrated left terminal internal carotid artery occlusion and low-intensity signal on T2*-weighted imaging at the occlusion site. Alteplase was administered and endovascular treatment was subsequently performed. A small-diameter microcatheter was guided to the distal end of the occlusion and angiography after deployment of a stent retriever revealed irregular stenosis. Severe stenosis remained after thrombectomy, and balloon angioplasty was added. The treatment resulted in recanalization and good outcome.
Adults with moyamoya disease may have accompanying atherosclerotic intracranial artery occlusion. Angiography after deployment of a stent retriever was useful for clarifying the etiology of occlusion. It is important to determine the etiology of occlusion based on the medical history or imaging findings and to select an appropriate treatment.
我们报告一例成年起病的烟雾病患者发生急性颈内动脉闭塞，该患者接受了机械取栓术并取得了良好预后。
一名73岁女性在59岁时因无症状性右侧大脑中动脉闭塞被诊断为烟雾病。该患者因中风症状被送来就诊。磁共振成像（MRI）显示左颈内动脉末端闭塞，闭塞部位在T2*加权成像上呈低强度信号。给予了阿替普酶并随后进行了血管内治疗。将一根小直径微导管引导至闭塞远端，在部署支架取栓器后进行血管造影显示不规则狭窄。取栓术后仍存在严重狭窄，遂加用球囊血管成形术。治疗导致血管再通且预后良好。
成年烟雾病患者可能伴有动脉粥样硬化性颅内动脉闭塞。部署支架取栓器后的血管造影有助于明确闭塞病因。根据病史或影像学表现确定闭塞病因并选择合适的治疗方法很重要。
