Morita Takahiro, Akitaya Sakura, Munakata Ryu-Ichi, Saito Atsushi
Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN.
Cureus. 2024 Dec 8;16(12):e75317. doi: 10.7759/cureus.75317. eCollection 2024 Dec.
Tandem occlusion due to acute cervical carotid artery dissection should be promptly treated with thrombectomy for reperfusion. If the cervical lesion has reached severe stenosis or complete occlusion, balloon angioplasty and, in certain cases, carotid artery stenting should be performed before thrombectomy for the intracranial lesion. Angioplasty or stent placement is performed in the true lumen, but securing the placement is challenging when the true lumen cannot be determined. In contrast, stenting in the false lumen of a carotid artery dissection is considered contraindicated. Although reports on a few similar cases have been published, no obvious complications are known, and the actual risks and outcomes remain unclear. We report the case of a 49-year-old woman with acute ischemic stroke who had tandem occlusion of the cervical internal carotid and middle cerebral arteries due to acute cervical dissection. The cervical lesion was completely occluded with no true lumen, and securing the true lumen proved extremely difficult. Therefore, we performed intracranial thrombectomy via the false lumen, followed by carotid artery stenting from the distal to the proximal true lumen via the false lumen. Six months later, follow-up examinations revealed no obvious complications. Our literature review identified only three reports of stenting in the false lumen of an acute carotid artery dissection, and no apparent complications were reported in any of these cases. Furthermore, the technique of recanalization through the false lumen is well established in chronic total occluded lesions of coronary or peripheral arteries when the true lumen cannot be secured. Therefore, access to the intracranial artery via the false lumen may be acceptable in situations of simultaneous intracranial arterial occlusion requiring rapid recanalization where securing a true lumen is challenging.
急性颈内动脉夹层导致的串联闭塞应立即进行血栓切除术以实现再灌注。如果颈部病变已达到严重狭窄或完全闭塞，应在对颅内病变进行血栓切除术之前，先进行球囊血管成形术，在某些情况下还需进行颈动脉支架置入术。血管成形术或支架置入术在真腔内进行，但当无法确定真腔时，确保其放置具有挑战性。相比之下，在颈动脉夹层的假腔内进行支架置入被认为是禁忌的。尽管已发表了一些关于类似类似的类似病例报告，但尚无明显并发症，实际风险和结果仍不明确。我们报告了一例49岁急性缺血性中风女性患者，因急性颈部夹层导致颈内动脉和大脑中动脉串联闭塞。颈部病变完全闭塞，无真腔，确定真腔极为困难。因此，我们通过假腔进行了颅内血栓切除术，随后通过假腔从远端到近端真腔进行了颈动脉支架置入术。六个月后，随访检查未发现明显并发症。我们的文献综述仅发现三篇关于在急性颈动脉夹层假腔内进行支架置入的报告，且这些病例均未报告明显并发症。此外，当无法确定真腔时，通过假腔进行再通的技术在冠状动脉或外周动脉慢性完全闭塞病变中已得到充分确立。因此，在需要快速再通的颅内动脉同时闭塞且确定真腔具有挑战性的情况下，通过假腔进入颅内动脉可能是可行的。
