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首页> 外文期刊>Journal of radiology case reports >Chronic innominate artery occlusion with hyperacute intracranial thromboembolism: Revascularization with simultaneous local thromboaspiration and mechanical thrombectomy
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Chronic innominate artery occlusion with hyperacute intracranial thromboembolism: Revascularization with simultaneous local thromboaspiration and mechanical thrombectomy

机译：慢性无创性动脉闭塞伴超急性颅内血栓栓塞：同时进行局部血栓抽吸和机械血栓切除术的血运重建

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Chronic innominate artery occlusion with acute right internal carotid terminus thromboembolism and successful revascularization using simultaneous local thromboaspiration and mechanical thrombectomy has not been previously described. A 51-year-old male presented with transient left hemiparesis. A CT angiogram of the head and neck demonstrated chronic occlusion of the right innominate artery with no intracranial thromboembolism. More profound symptoms recurred twelve hours after admission. A diagnostic catheter-based angiogram confirmed occlusion of the innominate artery and identified hyper-acute right carotid terminus thromboembolism. Angioplasty of the innominate artery was followed by simultaneous mechanical and aspiration thrombectomy of the right internal carotid artery terminus. Combination local thromboaspiration and mechanical thrombectomy was shown in this case to be effective in achieving a favorable clinical outcome. Keywords: Carotid-T thromboembolism, Innominate artery occlusion, Middle cerebral artery thromboembolism, Thromboaspiration, Mechanical thrombectomyCASE REPORTA 51-year-old male presented to the emergency room with left-sided weakness and right facial droop. Admission NIHSS (National Institute of Health Stroke Scale) score was 13 and blood pressure taken from the left arm was 154/79 mmHg with a pulse rate of 67 beats per minute. Past medical history was significant for a 20 pack year history of smoking and was otherwise unremarkable. There was no prior history of right upper arm claudication, syncope, vertigo, or visual impairment. Symptoms occurred with no prior activity of his right upper extremity.A non-contrast head computerized tomographic (CT) examination identified no intracranial hemorrhage or early changes of acute ischemic injury (Fig. 1A). A CT angiogram (CTA) of the head and neck after initial clinical evaluation demonstrated no carotid bifurcation stenosis or intracranial large vessel thromboembolic occlusion (Fig. 1B,C). A brain MRI examination with evaluation of diffusion and apparent diffusion coefficient (ADC) sequences demonstrated no acute brain parenchymal infarction (Fig. 1D,E,F). The CTA evaluation did however demonstrate occlusion of the proximal right innominate artery (IA) with opacification of a diminutive right cervical internal carotid artery (ICA) relative to the contralateral side. The non-dominant right cervical vertebral artery (VA) and the right subclavian artery (SA) were patent. Increased right hemispheric cortical branch vascularity relative to the left was identified. Diminished caliber of the right common carotid artery (CCA) and right ICA with increased ipsilateral hemispheric cortical branch vessels suggested chronic IA artery occlusion with right hemispheric pial collaterals (Fig. 2A, B and C). No CTA findings compatible with fibromuscular dysplasia (FMD) or vasculitis was noted. No cervical ribs were identified. A CT perfusion study was not performed as no intracranial thromboembolic occlusion was identified by CTA. The Electroencephalography (EEG) study and the serum coagulation profile were normal. Open in a separate windowFigure 1 A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.Findings: A: Select axial non contrast head CT image slice shows no attenuation change compatible with right hemispheric infarction. No dense right middle cerebral artery sign compatible with thrombus is identified (black arrow). B: Maximum intensity projection CTA shows patent right carotid terminus (thick black arrow) and right proximal middle cerebral artery (thin black arrow). C: Curved planar sagittal reformat CTA demonstrates a normal caliber and contour of the right distal common carotid artery, carotid bifurcation and internal carotid artery. D, E and F: Select axial FLAIR (D), axial diffusion (E) and axial apparent diffusion coefficient (ADC) mapped sequence (F) slices show no signal change compatible with right hemispheric infarction.Technique: A: Axial CT mA330, 140 kV, Slice thickness 2.5mm. B: Axial CT, 480mAs, 140kV, Slice thickness 10mm, 75 ml Isovue 370 injection at 4ml/second. C: Axial CT, 480mAs, 140kV, Slice thickness 0.63, 75 ml Isovue 370 injection at 4ml/second. D: Axial FLAIR TR 8000 TE 128.90, Slice thickness 5mm. E: Axial Diffusion, TR8600 TE80.10, Slice thickness 5mm. F: Axial ADC Axial Diffusion, TR8600 TE80.10, Slice thickness 5mm.
机译：先前没有描述过慢性无症状的动脉闭塞，急性右颈内动脉末端血栓栓塞和同时进行局部血栓抽吸和机械血栓切除术的成功血运重建。一名51岁男性出现短暂性左偏瘫。头部和颈部的CT血管造影照片显示右无名动脉慢性阻塞，无颅内血栓栓塞。入院十二小时后出现更深刻的症状。基于导管的诊断性血管造影证实了无名动脉的阻塞，并确定了超急性右颈总站血栓栓塞。在对无名动脉进行血管成形术后，同时对右侧颈内动脉总站进行机械和抽吸血栓切除术。在这种情况下，结合局部血栓抽吸和机械血栓切除术可有效实现良好的临床效果。关键字：颈动脉T血栓栓塞，无名动脉闭塞，脑中动脉血栓栓塞，血栓抽吸，机械血栓切除术病例报告51岁的男性因左手无力和面部下垂而被送往急诊室。入院NIHSS（美国国家卫生研究院卒中量表）得分为13，左臂血压为154/79 mmHg，脉搏率为每分钟67次。过去的病史对于吸烟20包年的历史很重要，否则就不明显了。没有右上肢lau行，晕厥，眩晕或视力障碍的病史。症状没有出现在他的右上肢之前的活动。无对比头的计算机断层扫描（CT）检查没有发现颅内出血或急性缺血性损伤的早期改变（图1A）。初步临床评估后，头颈部的CT血管造影（CTA）显示没有颈动脉分叉狭窄或颅内大血管血栓栓塞（图1B，C）。评估扩散和表观扩散系数（ADC）序列的脑部MRI检查未发现急性脑实质梗塞（图1D，E，F）。但是，CTA评估确实显示了相对于对侧的右颈小颈内动脉（ICA）的浑浊，阻塞了近端右无名动脉（IA）。非显性右颈椎动脉（VA）和右锁骨下动脉（SA）已获得专利。鉴定出相对于左侧，右半球皮质分支血管的增加。右颈总动脉（CCA）和右ICA的口径减小，同侧半球皮质分支血管增加，提示慢性IA动脉闭塞，右半球皮质侧支（图2A，B和C）。没有发现与纤维肌发育不良（FMD）或血管炎相容的CTA发现。没有发现颈肋。由于没有通过CTA确认颅内血栓栓塞闭塞，因此未进行CT灌注研究。脑电图（EEG）研究和血清凝血状况正常。在单独的窗口中打开图1一名51岁的男性，表现为急性暂时性左侧无力。通过最初的CT血管造影术确定了无症状的慢性动脉闭塞性疾病，没有颅内血栓栓塞性闭塞。左侧无力的早期复发和恶化促使进行了基于导管的血管造影研究，确定了右颈总站的超急性血栓栓塞。结果发现：A：选择轴向非对比头CT图像切片显示与右半球梗死无衰减变化。未发现与血栓相容的右脑中动脉稠密征象（黑色箭头）。 B：最大强度投影CTA显示右颈总动脉末端（黑色粗箭头）和右中脑近端动脉（黑色粗箭头）。 C：弯曲的平面矢状位CTA显示右远端颈总动脉，颈分叉和颈内动脉的正常口径和轮廓。 D，E和F：选择轴向FLAIR（D），轴向扩散（E）和轴向表观扩散系数（ADC）映射序列（F）切片显示与右半球梗死不兼容的信号变化。技术：A：轴向CT mA330， 140 kV，切片厚度2.5mm。 B：轴向CT，480mAs，140kV，切片厚度10mm，以4ml /秒注射75ml Isovue 370。 C：轴向CT，480mAs，140kV，切片厚度0.63，以4ml /秒注射75ml Isovue 370。 D：轴向FLAIR TR 8000 TE 128.90，切片厚度5mm。 E：轴向扩散，TR8600 TE80.10，切片厚度5mm。 F：轴向ADC轴向扩散，TR8600 TE80.10，切片厚度5mm。

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