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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >'Malignant' carotid artery dissection.
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'Malignant' carotid artery dissection.

机译：“恶性”颈动脉解剖。

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PURPOSE: Carotid artery dissection resulting in occlusion or severe narrowing and massive intracranial embolism can result in life-threatening hemispheric ischemia. Aggressive endovascular and microsurgical measures may be necessary to salvage life and minimize stroke morbidity in this extreme situation. PATIENTS AND METHODS: We have treated two middle-aged women who presented within an hour of spontaneous cervical internal carotid artery (ICA) dissection causing hemiplegia, forced head and eye deviation, and declining consciousness. The first patient had a carotid occlusion through which a catheter could not be passed, so intracranial thrombolysis was achieved through a microcatheter navigated through the posterior circulation. Surgical intimectomy and thrombectomy of the dissected ICA was then carried out using an intraoperative Fogarty arterial embolectomy catheter passed up the dissected ICA, followed by endovascular stenting of the reopened cervical ICA. The second patient underwent intracranial microsurgical embolectomy and, after an unsuccessful attempt of stenting the dissected and severely narrowed cervical ICA, surgical reopening again with a Fogarty catheter. Both patients suffered basal ganglionic infarcts but most of the middle cerebral artery territories were preserved and the patients made satisfactory recoveries. CONCLUSIONS: "Malignant" carotid artery dissection causing occlusion or near occlusion with intracranial embolism is an important cause of severe and life-threatening hemispheric ischemia. Treatment should include aggressive endovascular and microsurgical interventions when the hemisphere is at risk.
机译：目的：颈动脉夹层解剖导致闭塞或严重狭窄，大量颅内栓塞可导致威胁生命的半球缺血。在这种极端情况下，可能需要采取积极的血管内和显微手术措施来挽救生命并使中风发病率降至最低。患者和方法：我们治疗了两名中年妇女，他们在一小时内出现自发性颈内动脉（ICA）解剖，导致偏瘫，强迫的头和眼偏斜以及意识下降。第一例患者的颈动脉闭塞，无法通过导管，因此通过在后循环中导航的微导管实现了颅内溶栓。然后使用术中经切开的ICA的Fogarty动脉栓塞切除术导管进行切开的ICA的手术内膜切除和血栓切除术，然后对重新开放的子宫颈ICA进行血管内支架置入术。第二例患者接受了颅内显微外科手术栓塞切除术，并且在未成功地将解剖的和严重狭窄的子宫颈ICA支架置入支架后，再次通过Fogarty导管再次手术。两名患者均发生了基底节性梗塞，但大部分大脑中动脉区域得以保留，患者康复良好。结论：导致颅内栓塞的“恶性”颈动脉夹层闭塞或接近闭塞是严重且威胁生命的半球缺血的重要原因。当半球处于危险中时，治疗应包括积极的血管内和显微外科手术干预。

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