Endovascular treatment for acute tandem occlusion of proximal internal carotid artery and intracranial large artery

doi:10.3969/j.issn.1672-6731.2020.05.008

Abstract

Abstract:

Objective To evaluate the efficacy and safety of endovascular treatment (EVT) for acute tandem occlusion of proximal internal carotid artery (ICA) and intracranial large artery. Methods Five patients presented with acute tandem occlusion of proximal and intracranial ICA and middle cerebral artery (MCA) presented from August to November 2018 were included. Every patient was treated with proximal ICA stenting first and then intracranial artery sent thrombectomy. The result of revascularization was recorded with Thrombolysis in Cerebral Infarction (TICI) at the end of procedure. The outcome at 3 d, 90 d and one year postprocedure was evaluated with modified Rankin Scale (mRS). Results Proximal ICA stenting was successful and intracranial artery sent thrombectomy was performed in all patients. TICI grade 2b-3 was achieved in 4 patients and TICI grade 2a in one patient immidiately after surgery vascular recanalization rate was 4/5. There was no intracranial hemorrhage and more infarction. All patients had improved significantly. At 90 d after discharge, 2 patients had a mRS score 0, 2 patients had a mRS score 2, one patient had a mRS score 3. After one year, all patients remained a favorable clinical outcome (mRS score 0-1). Conclusions For patients presented with acute tandem occlusion of proximal ICA and intracranial large artery, antegrade recanalization with proximal ICA stenting and intracranial sent thrombectomy are safe and efficacious.

Key words: Arterial occlusive diseases, Carotid artery, internal, Middle cerebral artery, Stents, Cerebral angiography

摘要：

目的探讨颈内动脉起始部闭塞串联颈内动脉颅内段和大脑中动脉闭塞致急性缺血性卒中患者血管内治疗的有效性和安全性。方法 2018年8-11月共5例颈内动脉起始部闭塞串联颈内动脉颅内段和大脑中动脉闭塞患者，均行颈内动脉起始部支架植入术，再行颅内动脉支架取栓术。术后即刻采用脑梗死溶栓血流分级（TICI）评价血管再通程度，术后3 d、90 d和1年采用改良Rankin量表（mRS）评价预后。结果 5例患者均顺利完成颈内动脉起始部支架植入术以及颈内动脉颅内段和大脑中动脉支架取栓术，手术成功率为5/5。术后即刻TICI分级3级2例、2b级2例、2a级1例，血管再通率为4/5，未发生颅内出血或动脉再闭塞，神经功能明显改善。术后90 d mRS评分0分2例，2分2例，3分1例。术后1年均预后良好（mRS评分0~1分）。结论颈内动脉起始部闭塞串联颈内动脉颅内段和大脑中动脉闭塞致急性缺血性卒中患者，急诊行颈内动脉起始部支架植入术并顺行颅内动脉支架取栓术安全、有效。

关键词: 动脉闭塞性疾病, 颈内动脉, 大脑中动脉, 支架, 脑血管造影术

SHANG Yan-guo, SUN Tao, WANG Xuan, GAO Kai-ming, TONG Xiao-guang. Endovascular treatment for acute tandem occlusion of proximal internal carotid artery and intracranial large artery[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 413-418.

尚彦国, 孙涛, 王轩, 高恺明, 佟小光. 急性颈内动脉起始部和颅内大血管串联闭塞的血管内治疗[J]. 中国现代神经疾病杂志, 2020, 20(5): 413-418.

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https://journal11.magtechjournal.com/cjcnn/EN/Y2020/V20/I5/413

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