方法:由于文献证据不足,经肱动脉入路(TBA)的机械血栓切除术(MT)在主动脉病变和急性缺血性卒中(AIS)的患者中非常罕见。从技术角度来看的困难和该技术的结果受到经常伴随它的并发症的影响。
背景:文献中仅报道了少数主动脉病变和急性缺血性卒中患者通过TBA进行MT,在AIS应急管理中的应用还没有详细的论述。
目的:出于澄清和明确强调这种方法在AIS和主动脉病变患者中通过TBA进行急诊MT的有效性的需要,本文献回顾和病例报告具有以下目的:第一个是在44岁的AIS患者中通过经肱动脉入路进行的急诊MT,并在经股动脉入路(TFA)期间被诊断为主动脉缩窄,在我们部门成功进行再灌注,第二个是回顾文献中MT通过TBA进行的不同主动脉病理和AIS再灌注治疗的患者的病例报告。
方法:总共9例(1例个人病例和8例发表病例)根据主动脉病理类型进行了修订,再灌注治疗类型,以及机械取栓和局部经臂入路的并发症。
结果:在超过一半的病例中,通过经臂入路的机械血栓切除术是首选(55.55%,n=5例)在先前诊断为主动脉病变的情况下治疗急性缺血性中风。在所有病例的三分之一(33.33%,n=3,我们的病例和2例文献报告),在尝试推进引导导管通过经股动脉入路和术中主动脉病理诊断后,选择经肱动脉入路.只有一种情况,在对显示单相血流的桡动脉进行超声评估后,MT通过TBA进行。报告1例经肱局部并发症,在另外两种情况下,没有说明是否有这种并发症。据报道,有2例通过TBA进行仅MT脑再灌注的AIS出血性转化,1例急性主动脉夹层A型和我们以前未诊断的主动脉缩窄病例。在报告了短期和长期随访的病例中,治疗的结果,这并非完全是血管内(77.77%的病例仅有MT,33.33%的病例与首次溶栓和MT后相关),很好(9名患者中有6名)。在两个案例报告中,结果没有说明,一名患者在重症监护病房长期住院后死于呼吸系统并发症(我们的患者)。
结论:作为临床紧急情况,急性缺血性卒中需要紧急医疗干预.在主动脉病变患者中,急性缺血性卒中的急诊护理是一个挑战,经臂入路机械取栓是脑再灌注的安全替代方法。
METHODS: Mechanical thrombectomy (MT) via the transbrachial approach (TBA) is a very rare option used in cases of patients with aortic pathologies and acute ischemic stroke (AIS) due to the insufficient evidence in the literature, the difficulty from a technical point of view and the result of this technique influenced by the complications that frequently accompany it.
BACKGROUND: Only a few cases of patients with aortic pathologies and acute ischemic stroke where MT via TBA were reported in the literature, and its application in the emergency management of AIS has still not been dealt with in detail.
OBJECTIVE: Out of a need to clarify and clearly emphasize the effectiveness of this approach in emergency MT via TBA in patients with AIS and aortic pathologies, this literature review and case report has the following objectives: the first one is the presentation of an emergency MT via transbrachial approach performed in a 44-year-old patient with AIS and diagnosed aortic coarctation during transfemural approach (TFA), with successful reperfusion in our department and the second one is to review the cases reports of patients with different aortic pathologies and AIS reperfusion therapy performed by MT via TBA from the literature.
METHODS: A total of nine cases (one personal case and eight published cases) were revised in terms of aortic pathologies type, reperfusion therapy type, and the complication of both mechanical thrombectomy and local transbrachial approach.
RESULTS: Mechanical thrombectomy through the transbrachial approach was the first choice in more than half of these cases (55.55%, n = 5 cases) in the treatment of acute ischemic stroke in the presence of previously diagnosed aortic pathologies. In one-third of all cases (33.33%, n = 3, our case and 2 case reports from the literature), the transbrachial approach was chosen after attempting to advance the guiding catheter through the transfemoral approach and intraprocedural diagnosis of aortic pathology. In only one case, after an ultrasound evaluation of the radial artery that showed a monophasic flow, MT was performed via TBA. Local transbrachial complication was reported in one case, and in two other cases, it was not stated if there were such complications. Hemorrhagic transformation of AIS was reported in two cases that underwent MT-only cerebral reperfusion via TBA, one with acute aortic dissection type A and our case of previously undiagnosed aortic coarctation. In the cases in whom short and long-term follow-up was reported, the outcome of treatment, which was not exclusively endovascular (77.77% cases with only MT and 33.33% with association of first thrombolysis and after MT), was good (six from nine patients). In two case reports, the outcomes were not stated, and one patient died after a long hospitalization in the intensive care unit from respiratory complications (our patient).
CONCLUSIONS: Being a clinical emergency, acute ischemic stroke requires urgent medical intervention. In patients with aortic pathologies, where acute ischemic stroke emergency care is a challenge, mechanical thrombectomy via the transbrachial approach is a safe alternative method for cerebral reperfusion.