Medina Christopher S, Jijelava Sardion, Dancour Elie, Wright Paul
Division of Neurology, Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, NY, USA.
Department of Neurology, HealthAlliance Hospital, Westchester Medical Center Health Network, Kingston, NY, USA.
Korean J Neurotrauma. 2024 Jun 4;20(2):113-124. doi: 10.13004/kjnt.2024.20.e16. eCollection 2024 Jun.
The first objective of this case series was to describe the case of a patient with severe symptomatic left internal carotid artery stenosis after a recent stroke. Several days after stent placement by transcarotid artery revascularization, the patient developed a left-sided subdural hematoma. The patient then underwent embolization of the left middle meningeal artery (MMA) despite blocked access to the left MMA because of an internal carotid stent. The external carotid artery was accessed by passing a guiding catheter through the stent wall. We describe this method as "intrawall access." This allowed a coaxial system to deliver polyvinyl alcohol particles to the MMA for embolization. Embolization was successfully performed, with the stent integrity and blood flow through it remaining uncompromised. Overall, we demonstrated a new method of access through a previously placed internal carotid stent to gain neurointerventional access to the external carotid artery, which was jailed by a stent, for treating an acute subdural hematoma via MMA embolization. The second objective of this case series was to demonstrate the first MMA embolization in literature carried out in the acute or acute-on-subacute setting, in this case, and in four others.
本病例系列的首要目标是描述一名近期发生卒中后出现严重症状性左颈内动脉狭窄患者的情况。经颈动脉血管重建术置入支架几天后，该患者发生了左侧硬膜下血肿。尽管由于颈内动脉支架导致无法直接进入左脑膜中动脉（MMA），但患者随后仍接受了左脑膜中动脉栓塞术。通过将引导导管穿过支架壁进入颈外动脉。我们将这种方法称为“壁内入路”。这使得能够通过同轴系统将聚乙烯醇颗粒输送至脑膜中动脉进行栓塞。栓塞术成功实施，支架完整性及其内血流未受影响。总体而言，我们展示了一种通过先前置入的颈内动脉支架获得进入颈外动脉的神经介入通路的新方法，该颈外动脉被支架阻挡，通过这种方法可经脑膜中动脉栓塞治疗急性硬膜下血肿。本病例系列的第二个目标是证明在本病例以及其他四个病例中，文献报道的首次在急性或亚急性发作期进行的脑膜中动脉栓塞术。
