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中华介入放射学电子杂志 ›› 2022, Vol. 10 ›› Issue (02) : 228 -232. doi: 10.3877/cma.j.issn.2095-5782.2022.02.019

病例报告

颈动脉穿刺联合"Y"型双支架技术治疗急性大脑中动脉闭塞困难取栓1例
刘超1, 郝继恒1, 张萌1, 王子栋1, 蒋群龙1, 刘卫东1, 代高磊2, 王继跃1, 张利勇1,()   
  1. 1. 252000 山东聊城,聊城市脑科医院血管神经外科
    2. 252000 山东聊城,聊城市脑科医院神经介入中心
  • 收稿日期:2021-06-02 出版日期:2022-05-25
  • 通信作者: 张利勇

Direct carotid artery puncture combined with endovascular Y-stent retriever technique for saddle embolus: a case report

Chao Liu1, Jiheng Hao1, Meng Zhang1   

  • Received:2021-06-02 Published:2022-05-25
引用本文:

刘超, 郝继恒, 张萌, 王子栋, 蒋群龙, 刘卫东, 代高磊, 王继跃, 张利勇. 颈动脉穿刺联合"Y"型双支架技术治疗急性大脑中动脉闭塞困难取栓1例[J]. 中华介入放射学电子杂志, 2022, 10(02): 228-232.

Chao Liu, Jiheng Hao, Meng Zhang. Direct carotid artery puncture combined with endovascular Y-stent retriever technique for saddle embolus: a case report[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(02): 228-232.

图1 DSA显示腹部取栓通路迂曲伴主动脉"Ⅲ型"弓1A:DSA显示腹主动脉迂曲明显;1B主动脉弓及分支造影显示"Ⅲ型"弓。
图2 颈动脉穿刺成功植入颈动脉鞘并将导引导管体外固定2A:颈动脉穿刺成功后透视证实泥鳅导丝走行在颈动脉管腔;2B:泥鳅导丝引导下植入6Fr动脉鞘,并将动脉鞘以4#丝线固定于颈部皮肤;2C:路途指引下将6Fr动脉鞘到位右侧颈内动脉起始部;2D:8Fr导引导管头端与6Fr动脉鞘尾端以4#丝线固定。
图3 闭塞责任血管经过3次单支架取栓未能再通3A:经微导丝引导,Rebar-18微导管到位血管闭塞段;3B:手推造影证实微导管在血管真腔;3C:Solitaire-FR 6 × 30 mm单支架采用"SWIM"技术取栓;3D:经过3次单支架取栓后,左侧大脑中动脉M1段以远仍未见前向血流,考虑血栓同时累及大脑中动脉分叉上干、下干。
图4 闭塞责任血管经过1次双支架血管内治疗实现再通4A:Solitaire-FR 6 × 30 mm首先到位左侧大脑中动脉上干,随后Solitaire-FR 4 × 20 mm到位左侧大脑中动脉下干;4B:5Fr Navien中间导管跨过左侧大脑前动脉A1段高到位至左侧大脑中动脉M1段近端;4C:联合5Fr Navien中间导管持续负压抽吸的同时回撤两枚支架;4D:观察20 min后,造影见恢复TICI 3级血流。
图5 造影证实取栓路径血管无异常缝合颈动脉穿刺点5A:双支架取栓后可见支架间血栓附着;5B:取栓操作术后同侧颈总动脉造影未见夹层及脑血管痉挛征象;5C:肉眼直视下确切缝合颈动脉穿刺点;5D:术后患者血栓病理报告提示为混合型血栓。
图6 患者术后90 d随访CT、CTA6A:颅脑CT平扫提示左侧颞叶局限性低密度灶;6B:头颈部CTA提示左侧大脑中动脉管腔通畅。
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