Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa‑shi, Chiba, Japan
Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa‑shi, Chiba, Japan.
BMJ Case Rep. 2023 Oct 24;16(10):e256134. doi: 10.1136/bcr-2023-256134.
Thromboembolism is the most frequent complication of coil embolisation for intracranial aneurysm. Complications of thromboembolism can lead to stroke and have a serious impact on sequelae and mortality, necessitating appropriate rescue therapy. Here, we succeeded in recanalisation of an occluded stent by balloon-assisted local infusion of a thrombolytic agent following stent-assisted coil embolisation of an unruptured posterior communicating artery aneurysm. This method involves inflating a microballoon just distal to the occluded vessel and then administering a thrombolytic agent through a microcatheter. This technique may increase the rate of vessel reopening by maximising the local drug concentration. This method can be applied to any type of thrombolytic agent and helps reduce the dose of systemic drugs, which might decrease the incidence of haemorrhagic complications. Balloon-assisted intra-arterial thrombolytic infusion for an occluded vessel during endovascular coil embolisation could offer an alternative rescue therapy when conventional thrombolytic agent administration fails to improve thromboembolism.
血栓栓塞是颅内动脉瘤线圈栓塞治疗中最常见的并发症。血栓栓塞的并发症可导致中风，并对后遗症和死亡率产生严重影响，因此需要进行适当的抢救治疗。在这里，我们成功地通过在支架辅助线圈栓塞未破裂的后交通动脉瘤后，经球囊辅助局部输注溶栓剂，使闭塞的支架再通。该方法包括在闭塞血管的远端充气微球囊，然后通过微导管给予溶栓剂。这种技术可以通过最大化局部药物浓度来提高血管再通率。该方法可应用于任何类型的溶栓剂，并有助于减少全身药物的剂量，从而降低出血性并发症的发生率。在血管内线圈栓塞期间，对于闭塞的血管进行球囊辅助的动脉内溶栓输注，在常规溶栓剂治疗失败时，可以提供一种替代的抢救治疗方法。
