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支架取栓器意外脱离:2例报告

Inadvertent Detachment of Stent Retrievers: Report of 2 Cases.

作者信息

Ok Taedong, Yoon Pyeong Ho, Seo Kwon-Duk

机构信息

Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

出版信息

Neurointervention. 2024 Nov;19(3):180-184. doi: 10.5469/neuroint.2024.00409. Epub 2024 Oct 21.

DOI:10.5469/neuroint.2024.00409
PMID:39428575
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11540475/
Abstract

Mechanical thrombectomy using a stent retriever is a widely-used technique for recanalizing occluded cerebral arteries in acute ischemic stroke. Although rare, inadvertent stent detachment has primarily been reported with earlier stent retriever designs. We present 2 cases of inadvertent stent detachment with the pRESET stent. In the first case, an elderly patient presented with right middle cerebral artery occlusion and experienced stent detachment during the second retrieval. Despite this, successful recanalization was achieved through balloon angioplasty. In the second case, an elderly patient experienced stent detachment after the third retrieval, and recanalization of the M1 segment was unsuccessful due to the inability to pass the microcatheter. The first patient had a modified Rankin scale (mRS) score of 3, while the second had a poor prognosis with an mRS score of 5. These cases highlight that inadvertent stent detachment can impact outcomes, and balloon angioplasty may serve as a useful salvage therapy.

摘要

使用支架取栓器进行机械取栓是急性缺血性卒中时使闭塞脑动脉再通的一种广泛应用的技术。尽管罕见,但无意的支架脱离主要见于早期的支架取栓器设计。我们报告2例使用pRESET支架时发生无意支架脱离的病例。第一例,一名老年患者出现右侧大脑中动脉闭塞,在第二次取栓时发生支架脱离。尽管如此,通过球囊血管成形术成功实现了再通。第二例,一名老年患者在第三次取栓后发生支架脱离,由于无法通过微导管,M1段再通未成功。第一名患者改良Rankin量表(mRS)评分为3分,而第二名患者预后较差,mRS评分为5分。这些病例突出表明,无意的支架脱离可能影响预后,球囊血管成形术可能是一种有用的挽救治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/346e/11540475/13c189cc2c3a/neuroint-2024-00409f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/346e/11540475/3e040c52103f/neuroint-2024-00409f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/346e/11540475/13c189cc2c3a/neuroint-2024-00409f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/346e/11540475/3e040c52103f/neuroint-2024-00409f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/346e/11540475/13c189cc2c3a/neuroint-2024-00409f2.jpg

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Inadvertent Detachment of Stent Retrievers: Report of 2 Cases.支架取栓器意外脱离:2例报告
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本文引用的文献

1
Distal Medium Vessel Occlusion Strokes: Understanding the Present and Paving the Way for a Better Future.远端中等血管闭塞性卒中:了解现状并为更美好的未来铺平道路。
J Stroke. 2024 May;26(2):190-202. doi: 10.5853/jos.2023.02649. Epub 2024 May 30.
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Endovascular Therapy for Acute Stroke with a Large Ischemic Region.针对大面积缺血区域急性卒中的血管内治疗
N Engl J Med. 2022 Apr 7;386(14):1303-1313. doi: 10.1056/NEJMoa2118191. Epub 2022 Feb 9.
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Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy-A Clinical and Biomechanical Perspective.
机械取栓过程中支架取栓器意外脱离——临床与生物力学视角
Life (Basel). 2021 Jul 6;11(7):658. doi: 10.3390/life11070658.
4
Stroke thrombectomy complication management.脑卒中取栓术并发症的管理。
J Neurointerv Surg. 2021 Oct;13(10):912-917. doi: 10.1136/neurintsurg-2021-017349. Epub 2021 Jun 22.
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Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct.发病后 6 至 24 小时内进行取栓术治疗与缺损和梗死不匹配的脑卒中。
N Engl J Med. 2018 Jan 4;378(1):11-21. doi: 10.1056/NEJMoa1706442. Epub 2017 Nov 11.
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Solitaire stentectomy: 'deploy and engage' and 'loop and snare' techniques.Solitaire支架取栓术:“释放并套入”和“成袢并圈套”技术。
BMJ Case Rep. 2016 Aug 12;2016:bcr2016012547. doi: 10.1136/bcr-2016-012547.
7
Inadvertent Stent Retriever Detachment: A Multicenter Case Series and Review of Device Experience FDA Reports.不经意的支架取栓器脱离:一项多中心病例系列研究及对FDA报告中器械使用经验的回顾
Interv Neurol. 2016 Mar;4(3-4):75-82. doi: 10.1159/000441920. Epub 2015 Nov 20.
8
Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques.采用Solumbra或ADAPT技术进行机械取栓治疗的急性缺血性卒中患者的临床结局比较。
J Neurointerv Surg. 2016 Nov;8(11):1123-1128. doi: 10.1136/neurintsurg-2015-012122. Epub 2015 Dec 14.
9
Unexpected Detachment of Solitaire Stents during Mechanical Thrombectomy.机械取栓过程中Solitaire支架意外脱落
J Korean Neurosurg Soc. 2014 Dec;56(6):463-8. doi: 10.3340/jkns.2014.56.6.463. Epub 2014 Dec 31.
10
Clinical experience with the pREset stent retriever for the treatment of acute ischemic stroke--a review of 271 consecutive cases.用于治疗急性缺血性卒中的pREset取栓支架的临床经验——271例连续病例回顾
Neuroradiology. 2014 May;56(5):397-403. doi: 10.1007/s00234-014-1346-y. Epub 2014 Mar 12.