妊娠期合并机械心脏瓣膜的急性缺血性卒中伴大血管闭塞的机械取栓术：一例报告
Mechanical thrombectomy for acute ischemic stroke with large vessel occlusion in pregnancy with mechanical heart valves： A case report.
作者信息
Zhang Renwei, Peng Li, Xu Yao, Liu Yumin
机构信息
Department of Neurology, Zhongnan Hospital of Wuhan Universtiy, Wuhan, China.
Department of Cardiology, Zhongnan Hospital of Wuhan Universtiy, Wuhan, China.
出版信息
Heliyon. 2023 Jul 26;9(8):e18616. doi: 10.1016/j.heliyon.2023.e18616. eCollection 2023 Aug.
BACKGROUND
The management of anticoagulation for mechanical heart valves (MHVs) during pregnancy posed a special challenge. Mechanical thrombectomy (MT) was the standard treatment for acute ischemic stroke (AIS) in anterior circulation with large vessel occlusion. However, the efficacy and safety of MT in the treatment of acute ischemic stroke in pregnancy were unknown.
CASE PRESENTATION
A 29-year-old woman with MHVs in her first pregnancy at 7 weeks' gestation underwent MT because of a large occlusive thrombus in the end of the internal carotid artery despite therapeutic anticoagulation with low-molecular-weight heparin. This pregnant woman recovered well after MT with a modified rank score (mRS) of 0 at 90 days.
CONCLUSION
At present, there was no standard protocol of anticoagulation therapy for pregnant women with MHVs. Acute ischemic stroke with large vessel occlusion in pregnancy was rare, but could bring devastating consequences for both mother and infant. Our case report demonstrated that MT could be safe and effective in pregnancy.
背景
孕期机械心脏瓣膜（MHV）的抗凝管理面临特殊挑战。机械取栓术（MT）是前循环大血管闭塞性急性缺血性卒中（AIS）的标准治疗方法。然而，MT治疗孕期急性缺血性卒中的疗效和安全性尚不清楚。
病例介绍
一名29岁首次怀孕7周的患有MHV的女性，尽管使用低分子肝素进行了治疗性抗凝，但因颈内动脉末端巨大闭塞性血栓接受了MT治疗。该孕妇MT治疗后恢复良好，90天时改良Rankin量表（mRS）评分为0。
结论
目前，对于患有MHV的孕妇尚无标准的抗凝治疗方案。孕期大血管闭塞性急性缺血性卒中罕见，但可能给母婴带来灾难性后果。我们的病例报告表明，MT在孕期可能是安全有效的。
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