- 期刊
Thrombectomy for a Nonagenarian with Left Middle Cerebral Artery Occlusion and Bovine Arch: A Case Report and Literature Review
在有牛型主動脈弓、左側頸動脈迂曲、左側中大腦動脈阻塞的高齡長者施行經動脈取栓術：病例報告及文獻回顧
摘要
Background: Endovascular thrombectomy is beneficial for acute ischemic stroke. In the elderly, atherosclerosis and vessel tortuosity might lead to technical challenges and longer intervention time. Besides, the bovine arch prevented the guiding catheter to the target artery. Case report: A 98-year-old woman with hypertension, atrial fibrillation, and past stroke got left middle cerebral artery (MCA) infarction with drowsy consciousness, speech disturbance, and right limbs weakness. Computed tomography angiography with perfusion imaging showed left MCA M2 occlusion with large penumbra and no ischemic core. We also found a bovine arch with a left common carotid artery (CCA) kinking. We accessed via the femoral route with Neuron MAX 088 90 cm navigated with 5Fr. JB2, VTK, changing wire from 0.035 inches wires 150 cm to 260 cm, still failed to approach left CCA in eighty minutes. We then accessed the right brachial artery with Neuron MAX 088 coaxial with JB2 to the left proximal CCA. The tortuous left proximal CCA held back the Neuron MAX 088 to go further to the middle CCA. We then used 132 cm ACE 068 and 153 cm 3MAX to remove the thrombus at the left MCA. The NIHSS of the patient improved from 24 to 14 one day later. Conclusion: Delineating the route to the left MCA in a nonagenarian with bovine arch and tortuous left carotid artery before the procedure matters. The pre-operative planning and switching intra-operative strategy when struggles are essential.
並列摘要
經動脈取栓術對急性缺血性中風可減輕失能之程度。在老年人，動脈粥樣硬化、血管迂曲及牛型主動脈弓會阻止導管到達目標動脈及延長取栓所需時間。本文探討一名患有高血壓、心房顫動和曾有中風病史的98歲女性，呈現急性語言障礙、右側肢體無力及嗜睡症狀。電腦斷層掃描血管造影及灌流影像顯示左側中大腦動脈第二段血管阻塞，缺血範圍大而尚無梗死。此外，術前也看到左側總頸動脈由頭臂動脈分出之牛型主動脈弓。我們一開始經由股動脈穿刺，但未能在80分鐘之內將導管送至左側總頸動脈。隨後，我們採用右側肱動脈穿刺經頭臂動脈至左側近端總頸動脈。然而，我們無法以診斷導管進一步的將導引導管放至左側遠端總頸動脈。之後，我們使用132公分的抽吸導管（ACE 068）和153公分的較小抽吸導管（3 MAX）成功移除左側中大腦動脈第二段血管阻塞的血栓。術後一天，病患的NIHSS從24進步到14。由此案例報告及文獻回顧可知：在手術前之影像判斷及計畫非常重要，特別是在有牛型主動脈弓、左側頸動脈迂曲的高齡長者，術前計劃和及時更換策略非常重要。
延伸閱讀
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