Lv Shuangyun, Liu Ronghui, Sun Jiapeng, Liu Hongmei, Li Kun, Li Chong, Bian Jinhui, Ding Changxia, Guo Xin
Department of Neurology, Huanghua Municipal People's Hospital, Huanghua, Hebei, China.
Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
SAGE Open Med Case Rep. 2025 Sep 25;13:2050313X251381564. doi: 10.1177/2050313X251381564. eCollection 2025.
Stroke is the leading cause of death among Chinese residents, a common form of which is acute large-vessel occlusion ischemic stroke, characterized by high incidence, disability, and mortality rates. To improve stroke prognosis, mechanical thrombectomy has been promoted as an effective treatment, but it involves risks of such complications as hemorrhagic transformation (symptomatic or asymptomatic bleeding), new distal embolism, reocclusion, restenosis, intraoperative vascular dissection, perforation, spasm, and hyperperfusion syndrome. As a case study, this article reports a 66-year-old male patient who suddenly developed acute cerebral infarction with acute occlusion of the left middle cerebral artery M1 segment. After mechanical thrombectomy, the patient experienced a rare complication of Purtscher-like retinopathy, causing significant vision loss in the left eye. Fundus fluorescein angiography indicated occlusion of the branch retinal artery, considered to be caused by microemboli fragmentation, escape, and blockage of the branch retinal artery during mechanical thrombectomy. Follow-up at 1, 6 months, and 1 year after discharge showed no significant improvement in the patient's vision. An in-depth analysis of its mechanism and imaging features suggests that optimization of mechanical thrombectomy devices can significantly improve procedural outcomes. For instance, the use of intermediate catheters-such as the Penumbra ACE series or Navien catheters-in combination with stent retrievers can enhance thrombus engagement and retrieval efficiency, thereby reducing the risk of distal embolization and lowering the incidence of procedure-related complications.
中风是中国居民死亡的主要原因，其中常见的一种形式是急性大血管闭塞性缺血性中风，其特点是发病率、致残率和死亡率都很高。为改善中风预后，机械取栓术已被推广为一种有效的治疗方法，但它存在出血转化（有症状或无症状出血）、新的远端栓塞、再闭塞、再狭窄、术中血管夹层、穿孔、痉挛和高灌注综合征等并发症的风险。作为一个案例研究，本文报告了一名66岁男性患者，他突然发生急性脑梗死，伴有左大脑中动脉M1段急性闭塞。机械取栓术后，该患者出现了罕见的类似Purtscher样视网膜病变的并发症，导致左眼严重视力丧失。眼底荧光血管造影显示视网膜分支动脉闭塞，被认为是由于机械取栓过程中微栓子破碎、逸出并阻塞视网膜分支动脉所致。出院后1个月、6个月和1年的随访显示，患者的视力没有明显改善。对其机制和影像学特征的深入分析表明，优化机械取栓装置可显著改善手术效果。例如，使用中间导管（如Penumbra ACE系列或Navien导管）与支架取栓器相结合，可以提高血栓捕获和取出效率，从而降低远端栓塞的风险并降低手术相关并发症的发生率。
