Ohshima Tomotaka, Miyachi Shigeru
Neuroendovascular Therapy Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, Japan.
Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, Japan.
Asian J Neurosurg. 2024 Jun 5;19(2):301-304. doi: 10.1055/s-0044-1787083. eCollection 2024 Jun.
In acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best device or technique for the first attempt at mechanical thrombectomy remains a matter of debate. We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. A 74-year-old man presented with left-sided hemiplegia and was diagnosed with a right internal carotid artery occlusion. He underwent endovascular thrombectomy using a stent clot retriever. Although complete recanalization was achieved in the first pass, repeated middle cerebral artery occlusion occurred. Angiography revealed an irregular inner surface and thrombus formation in the superior branch of the second segment of the right middle cerebral artery. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against small branches. Antiplatelet therapy may be effective for preventing recurrent occlusion. We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against nonvisible small branches.
在急性缺血性卒中中，已有多种血管内治疗方法被报道，其再通率高且临床效果良好。然而，首次机械取栓的最佳器械或技术仍存在争议。我们报告一例病例，首次使用支架取栓可能导致管腔内损伤，进而引起大脑中动脉反复闭塞。一名74岁男性因左侧偏瘫就诊，被诊断为右侧颈内动脉闭塞。他接受了使用支架取栓器的血管内血栓切除术。尽管首次操作实现了完全再通，但大脑中动脉出现了反复闭塞。血管造影显示右侧大脑中动脉第二段上支内表面不规则且有血栓形成。由于支架取栓，尤其是使用大型支架处理小分支时，存在管腔内损伤的风险。抗血小板治疗可能对预防再发闭塞有效。我们报告一例病例，首次使用支架取栓可能导致管腔内损伤，进而引起大脑中动脉反复闭塞。由于支架取栓，尤其是使用大型支架处理不可见的小分支时，存在管腔内损伤的风险。
