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中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 336 -343. doi: 10.11817/j.issn.1673-9248.2021.05.013

病例报告

补救性支架植入治疗基底动脉取栓失败一例及文献复习
王也1, 付伟1, 李莹莹1, 武剑1,()   
  1. 1. 102218 清华大学附属北京清华长庚医院神经内科,清华大学临床医学院
  • 收稿日期:2020-12-20 出版日期:2021-10-09
  • 通信作者: 武剑

Rescue stenting for failed mechanical thrombectomy in acute basilar artery occlusive infarction: a case report and literature reviews

Ye Wang1, Wei Fu1, Yingying Li1   

  • Received:2020-12-20 Published:2021-10-09
引用本文:

王也, 付伟, 李莹莹, 武剑. 补救性支架植入治疗基底动脉取栓失败一例及文献复习[J]. 中华脑血管病杂志(电子版), 2021, 15(05): 336-343.

Ye Wang, Wei Fu, Yingying Li. Rescue stenting for failed mechanical thrombectomy in acute basilar artery occlusive infarction: a case report and literature reviews[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(05): 336-343.

图1 急性缺血性脑卒中患者头CT图。图a箭头所示为双侧小脑扁桃体低密度改变;图b箭头所示为小脑下脚低密度改变;图c箭头所示为右侧小脑半球低密度改变;图d箭头所示为右侧桥臂低密度改变;合计pc-ASPECTS评分为7分
图2 多模态CT血管成像。图a可见Ⅱ型主动脉弓,箭头所示右侧椎动脉纤细;图b箭头可见右侧椎动脉全程纤细V4段次全闭塞,左侧椎动脉为优势侧,左侧椎动脉供应后循环血流;图c圆圈内所示为基底动脉闭塞,且无后交通代偿,远端mTICI血流0级
图3 多模态CT灌注成像。图a箭头所指为脑干、双侧小脑半球达峰时间(TTP)及平均通过时间(MTT)显著延长,对比脑血流量(CBF)及脑血容量(CBV)可见小脑右侧、双侧脑干显著不匹配;图b箭头所指为双侧枕叶TTP及MTT显著延长,对比CBF及CBV可见双侧枕叶及部分右侧丘脑显著不匹配
图4 颅脑血管数字减影血管造影术复查图。图a可见患者Ⅱ型主动脉弓;图b箭头所指可见左侧优势椎动脉,圆圈内可见基底动脉闭塞;图c侧位造影圆圈内所示为基底动脉闭塞,远端mTICI血流0级
图5 患者颅内支撑导管辅助Solitaire支架取栓+抽吸术(SWIM)治疗。图a为取栓系统到位椎基底动脉系统,箭头所指为中间导管,圆圈内为微导管造影位于真腔且越过闭塞血栓段;图b为行SWIM技术1次血流mTICI 2a级重建,箭头所示病变处残余血栓;图c为SWIM技术1次吸出及取出的大量栓子;图d为更换大直径取栓支架后第2次SWIM操作;图e为再次取栓后血流mTICI 3级改善后无法有效维持;图f为取栓支架未见明显栓子成分取出;图g为观察10 min后残余狭窄(箭头所示);图h箭头所示狭窄远端造影充盈逐渐下降;图i为给予支架植入后可见血流mTICI 3级再通且无残余明显狭窄
图6 术后24 h复查头CT影像。后循环区域中:图a可见延髓回避梗死;图b箭头所示右侧小脑低密度梗死灶;图c箭头所示右侧桥臂低密度梗死灶;图d可见中脑回避梗死;图e箭头所示为外囊附近低密度梗死灶;图g箭头所示右侧丘脑低密度梗死灶;图h,i可见右侧枕叶稍低密度缺血灶;综上可见提示核心梗死区域体积明显小于术前多模灌注中不匹配体积,半暗带被有效挽回
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