Abstract

The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented.Man, 61 years old. He was delivered to the Center of endovascular neuroradiology, NAMS of Ukraine on January 15, 2021 with an ischemic stroke clinic in the left internal carotid artery basin. He fell ill acutely ‒ against the background of complete well-being, sensorimotor aphasia and right-sided hemiplegia appeared. Upon admission on the NIHSS (National Institutes of Health Stroke Scale) ‒ 18 points. On the performed initial multispiral computed tomography of the brain according to ASPECTS (Alberta Stroke Program Early CT score) ‒ 8 points. In the endovascular operating room, cerebral angiography was performed, followed by surgery aimed at restoring cerebral blood flow. The time from the onset of the disease to the puncture was 330 minutes, the duration of the operation was 135 minutes, thus the time from the onset of the disease to reperfusion was 465 minutes. Angiography revealed acute thrombosis of the left ICA starting from the orifice, M1-segment of the left MCA and A2-segment of the left ACA. Partial compensation of the basin through the supra-block anastomosis (external carotid artery ‒ ICA), as well as from the vertebro-basilar system through the network of leptomeningeal arteries. Collaterals ‒ ACG 3. Thrombosis of the right ICA and critical stenosis (95 %) of the V1-segment of the left vertebral artery were also revealed. The operation was performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty, thrombectomy from the MCA and ACA pools. The end result is eTICI 2c reperfusion. There were no complications during this operation. The patient was discharged the next day (transferred to the neurological department at the place of residence). Control multispiral computed tomography of the brain showed positive dynamics (ASPECTS ‒ 1 point).

Highlights

  • ПРИ ОСТРОМ ИШЕМИЧЕСКОМ ИНСУЛЬТЕГУ «Научно-практический Центр эндоваскулярной нейрорентгенохирургии НАМН Украины», г

  • He was delivered to the Center of endovascular neuroradiology

  • performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty

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Summary

ПРИ ОСТРОМ ИШЕМИЧЕСКОМ ИНСУЛЬТЕ

ГУ «Научно-практический Центр эндоваскулярной нейрорентгенохирургии НАМН Украины», г. Представлено наблюдение эндоваскулярного лечения острой тандемной окклюзии внутренней сонной (ВСА), передней мозговой (ПМА) и средней мозговой артерий (СМА) в сочетании с тромбозом правой ВСА и критическим стенозом левой позвоночной артерии. 61 год, доставлен в Научно-практический Центр эндоваскулярной нейрорентгенохирургии НАМН Украины 15.01.2021 г. По шкале ASPECTS (Alberta Stroke Program Early CT score) – 8 баллов. Время от начала заболевания до пункции составило 330 мин, продолжительность операции – 135 мин. На ангиограммах выявлен острый тромбоз левой ВСА, начиная с устья, М1-сегмента левой СМА и А2-сегмента левой ПМА. Также выявлен тромбоз правой ВСА и критический стеноз (95 %) V1-сегмента левой позвоночной артерии. Операция – реканализация тромбоза устья левой ВСА с последующей баллонной ангиопластикой, тромбэктомия из бассейнов СМА и ПМА. По данным контрольной мультиспиральной компьютерной томографии головного мозга выявлена положительная динамика (по шкале ASPECTS – 1 балл).

Церебральная ангиография
ЕНДОВАСКУЛЯРНЕ ЛІКУВАННЯ ТАНДЕМНИХ ОКЛЮЗІЙ ПРИ ГОСТРОМУ ІШЕМІЧНОМУ ІНСУЛЬТІ
ENDOVASCULAR TREATMENT OF TANDEMIC OCCLUSIONS IN ACUTE ISCHEMIC STROKE
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