Fu Y, Komiyama M, Inoue T, Ohata K, Matsuoka Y, Hakuba A
Department of Neurosurgery, Tsukazaki Hospital.
No Shinkei Geka. 1996 Oct;24(10):955-9.
We reported a case of middle cerebral artery occlusion caused by a dissecting aneurysm that was successfully treated by intra-arterial fibrinolysis. A 38-year-old man suddenly developed left hemiparesis and became confused. He was transferred to our hospital one hour and 27 minutes after the ictus. Right carotid angiogram (CAG) revealed aneurysmal dilatation of the horizontal portion of the middle cerebral artery and occlusion of the anterior trunk. Twelve million IU of tissue plasminogen activator was injected to fibrinolyze the thrombus of the occlusion site through a microcatheter. After this, the patient became alert and hemiparesis disappeared. It took three hours and 30 minutes to gain recanalization after the ictus. Right CAG obtained the next day demonstrated the patency of the anterior trunk and the characteristic finding of the dissecting aneurysm viz "double lumen" as a result of fibrinolysis of the thrombus in the false lumen. Right CAG obtained two weeks later demonstrated "string and pearl sign" instead of the "double lumen" as a result of partial thrombosis in the false lumen. Follow-up CAG obtained nine months after the ictus demonstrated marked reduction of the aneurysmal size as the result of progressing thrombosis of the false lumen. The characteristic angiographic findings of the dissecting aneurysm such as "double lumen" and "string and pearl sign" seemed to be mostly influenced by the status of the thrombus in the false lumen. In case of major cerebral arterial occlusion caused by the embolus or thrombus from the dissecting aneurysm, intra-arterial fibrinolysis seems to be a possible treatment modality, even though it is accompanied by the risk of giving rise to subarachnoid hemorrhage.
我们报告了一例由夹层动脉瘤导致的大脑中动脉闭塞病例，该病例通过动脉内纤溶治疗成功治愈。一名38岁男性突然出现左侧偏瘫并陷入意识模糊。发病后1小时27分钟，他被转送至我院。右侧颈动脉血管造影（CAG）显示大脑中动脉水平段动脉瘤样扩张及前主干闭塞。通过微导管注入1200万国际单位的组织型纤溶酶原激活剂，以溶解闭塞部位的血栓。此后，患者意识恢复清醒，偏瘫症状消失。发病后3小时30分钟实现再通。次日进行的右侧CAG显示前主干通畅，并且由于假腔内血栓的纤溶作用，出现了夹层动脉瘤的特征性表现，即“双腔征”。两周后进行的右侧CAG显示，由于假腔内部分血栓形成，“双腔征”被“串珠征”取代。发病后九个月进行的随访CAG显示，由于假腔内血栓形成进展，动脉瘤大小显著缩小。夹层动脉瘤的特征性血管造影表现，如“双腔征”和“串珠征”，似乎主要受假腔内血栓状态的影响。对于由夹层动脉瘤的栓子或血栓引起的大脑主要动脉闭塞病例，动脉内纤溶似乎是一种可行的治疗方式，尽管它伴有引发蛛网膜下腔出血的风险。
