Saito Takashi, Saito Takuya, Ishii Tatsuhito, Homma Kazunari, Kunii Yoshifumi, Koide Masaaki, Ohashi Toshihiko
Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN.
Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN.
Cureus. 2024 Jul 13;16(7):e64465. doi: 10.7759/cureus.64465. eCollection 2024 Jul.
Planning for the acute phase of ischemic stroke in postoperative patients with aortic dissection is difficult from the perspective of concerns about worsening disease related to aortic dissection due to intravenous thrombolytic agents and securing access routes when mechanical thrombectomy is planned. Herein, we report that a 52-year-old man underwent thoracic endovascular aortic repair for acute type B aortic dissection. One year after the procedure, the patient developed a stroke caused by stent graft thrombosis, and computed tomography angiography showed occlusion of the left common carotid artery and left internal carotid artery. Stroke neurologists performed mechanical thrombectomy via a direct approach from the left common carotid artery, and successful recanalization was achieved. Furthermore, ligation of the proximal portion of the left common carotid artery and bypass surgery on the distal portion of the left common carotid artery were performed by cardiovascular surgeons. Although the patient had a postoperative hemorrhagic infarction, he returned to work without a recurrence of stroke after two years of follow-up. A direct carotid artery puncture we performed is an alternative in cases of anatomical difficulty or an unfavorable aortic arch. This case highlights not only the significance of interdisciplinary collaboration between cardiac and neurological specialists but also the impact of training dual-specialty cerebrovascular neurosurgeons on patient outcomes.
从担心静脉溶栓药物会使主动脉夹层相关疾病恶化以及计划进行机械取栓时确保通路这两方面来看，为主动脉夹层术后患者规划缺血性卒中的急性期治疗颇具难度。在此，我们报告一名52岁男性因急性B型主动脉夹层接受了胸段血管腔内主动脉修复术。术后一年，患者因支架移植物血栓形成引发卒中，计算机断层血管造影显示左颈总动脉和左颈内动脉闭塞。卒中神经科医生通过直接经左颈总动脉的方法进行了机械取栓，并成功实现再通。此外，心血管外科医生对左颈总动脉近端进行了结扎，并对左颈总动脉远端进行了搭桥手术。尽管患者术后出现出血性梗死，但经过两年随访，他恢复了工作，且未再次发生卒中。我们所进行的直接颈动脉穿刺在解剖结构困难或主动脉弓情况不佳的病例中是一种替代方法。该病例不仅凸显了心脏科和神经科专家之间跨学科合作的重要性，还体现了培养双专业脑血管神经外科医生对患者预后的影响。
