PDF(Pubmed)
Abstract：
Planning for the acute phase of ischemic stroke in postoperative patients with aortic dissection is difficult from the perspective of concerns about worsening disease related to aortic dissection due to intravenous thrombolytic agents and securing access routes when mechanical thrombectomy is planned. Herein, we report that a 52-year-old man underwent thoracic endovascular aortic repair for acute type B aortic dissection. One year after the procedure, the patient developed a stroke caused by stent graft thrombosis, and computed tomography angiography showed occlusion of the left common carotid artery and left internal carotid artery. Stroke neurologists performed mechanical thrombectomy via a direct approach from the left common carotid artery, and successful recanalization was achieved. Furthermore, ligation of the proximal portion of the left common carotid artery and bypass surgery on the distal portion of the left common carotid artery were performed by cardiovascular surgeons. Although the patient had a postoperative hemorrhagic infarction, he returned to work without a recurrence of stroke after two years of follow-up. A direct carotid artery puncture we performed is an alternative in cases of anatomical difficulty or an unfavorable aortic arch. This case highlights not only the significance of interdisciplinary collaboration between cardiac and neurological specialists but also the impact of training dual-specialty cerebrovascular neurosurgeons on patient outcomes.
摘要：
从担心由于静脉溶栓药物引起的与主动脉夹层相关的疾病恶化以及计划机械血栓切除术时确保进入途径的角度来看，很难计划主动脉夹层术后患者的缺血性中风急性期。在这里，我们报道1例52岁男性因急性B型主动脉夹层接受了胸主动脉腔内修复术.手术一年后，患者出现了由支架移植物血栓形成引起的中风，计算机断层扫描血管造影显示左颈总动脉和左颈内动脉闭塞。卒中神经科医生通过从左颈总动脉直接入路进行机械血栓切除术，并成功实现了再通。此外，左颈总动脉近端结扎和左颈总动脉远端搭桥手术由心血管外科医师进行。虽然病人术后出血性梗死,经过两年的随访，他恢复了工作，没有中风复发。在解剖困难或主动脉弓不利的情况下，我们进行的直接颈动脉穿刺是一种替代方法。这个案例不仅强调了心脏和神经系统专家之间跨学科合作的重要性，而且还强调了培训双专业脑血管神经外科医生对患者预后的影响。
