Uezato Minami, Ikeda Hiroyuki, Kimura Genki, Osuki Takuya, Yokochi Yasunori, Kinosada Masanori, Kurosaki Yoshitaka, Chin And Masaki
Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan.
J Neurosurg Case Lessons. 2024 Oct 7;8(15). doi: 10.3171/CASE24406.
In cerebral large vessel occlusion, even when an aneurysm is close to the target vessel, if the aneurysm is relatively small and angiography shows no thrombus within the aneurysm, it is difficult to identify the aneurysm as the embolic source.
A 67-year-old man with a history of two left-sided cerebral infarctions developed a small left-sided cerebral infarction. On hospital day 3, he developed a left M2 occlusion and underwent thrombectomy with retraction of a stent retriever into an aspiration catheter at the proximal end of the thrombus. A red thrombus was retrieved, and M2 recanalization was successfully achieved. Angiography revealed a large partially thrombotic aneurysm with a small cavity with blood stagnation in the left cervical internal carotid artery, which was considered the embolic source. Stent-assisted coil embolization was performed on the aneurysm, and no recurrent cerebral infarction was observed after embolization.
In cerebral large vessel occlusion, an aneurysm cavity with blood stagnation may be the embolic source. Using an aspiration catheter alone or retracting a stent retriever into an aspiration catheter could be a useful technique and help to avoid interference between the aneurysm and the stent retriever. https://thejns.org/doi/10.3171/CASE24406.
在大脑大血管闭塞时，即使动脉瘤靠近目标血管，但如果动脉瘤相对较小且血管造影显示瘤内无血栓形成，很难将该动脉瘤确定为栓子来源。
一名有两次左侧脑梗死病史的67岁男性发生了一次小的左侧脑梗死。住院第3天，他出现左侧大脑中动脉M2段闭塞，并接受了血栓切除术，将支架取栓器回撤至血栓近端的抽吸导管内。取出了一个红色血栓，M2段成功再通。血管造影显示左侧颈内动脉有一个大的部分血栓形成的动脉瘤，瘤腔小且有血流停滞，考虑为栓子来源。对该动脉瘤进行了支架辅助弹簧圈栓塞，栓塞后未观察到复发性脑梗死。
在大脑大血管闭塞时，有血流停滞的动脉瘤腔可能是栓子来源。单独使用抽吸导管或将支架取栓器回撤至抽吸导管内可能是一种有用的技术，有助于避免动脉瘤与支架取栓器之间的干扰。https://thejns.org/doi/10.3171/CASE24406 。
