How to differentiate intracranial atherosclerotic disease or vasospasms after mechanical thrombectomy. Be patient or vasodilator is the secret?

Pagiola Igor; Amaral Bruno; Saito Celso; Nalli Darcio; Carrete Junior Henrique; Frudit Michel

doi:10.7461/jcen.2021.E2020.05.001

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저자정보: Pagiola Igor (Department of Interventional Neuroradiology Universidade Federal de São Paulo São Paulo SP Brazil) Amaral Bruno (Department of Interventional Neuroradiology Universidade Federal de São Paulo São Paulo SP Brazil) Saito Celso (Department of Interventional Neuroradiology Universidade Federal de São Paulo São Paulo SP Brazil) Nalli Darcio (Department of Interventional Neuroradiology Universidade Federal de São Paulo São Paulo SP Brazil) Carrete Junior Henrique (Department of Interventional Neuroradiology Universidade Federal de São Paulo São Paulo SP Brazil) Frudit Michel (Department of Interventional Neuroradiology Universidade Federal de São Paulo São Paulo SP Brazil)

저널정보: 대한뇌혈관외과학회 Journal of Cerebrovascular and Endovascular Neurosurgery Journal of Cerebrovascular and Endovascular Neurosurgery Vol.23 No.1

발행연도: 2021.3

수록면: 60 - 63 (4page)

DOI: 10.7461/jcen.2021.E2020.05.001

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Here we describe a successful mechanical thrombectomy (MT) for acute large vessel occlusion in stroke treatment with one passage (thrombolysis in cerebral infarction, TICI 3). Immediately after the withdrawing of the stent retriever, a narrowing of the middle cerebral artery was diagnosed. The rate of vasospasms during this procedure can be as higher as 41% (range from 6-41%). Here we describe our protocol when a narrowing of the artery is visualized after a stent retriever is withdrawn. A patient presented in our emergency room with National Institute of Health Stroke Scale (NIHSS) of 21, Alberta Stroke Program Early CT Score (ASPECTS) 8, computed tomography angiography revealed occlusion of the M1 segment and MT was indicated. One passage TICI Ⅲ was achieved. After that, the image showed a narrowing of the artery. We present one case of a spasm after stent retriever technique for MT, we injected vasodilator and the artery became normal in a few minutes differentiating between atheromatous stenosis and vasospasm. We present a technical note that can help to make the differentiation of vasospasm or atheromatous disease after MT with the stent retriever technique.

#Stroke #Vasospasms #Endovascular treatment #Ischemic stroke #Thrombectomy

참고문헌 (10)

참고문헌 신청

Akins PT / 2014 / Complications of endovascular treatment for acute stroke in the SWIFT trial with solitaire and Merci devices / AJNR Am J Neuroradiol 35(3):524~528

Berkhemer OA / 2015 / A randomized trial of intraarterial treatment for acute ischemic stroke / N Engl J Med 372(1):11~20

Bracard S / 2016 / Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke(THRACE) : a randomized controlled trial / Lancet Neurol 15(11):1138~1147

Campbell BC / 2015 / Endovascular therapy for ischemic stroke with perfusion-imaging selection / N Engl J Med 372(11):1009~1018

Chalumeau V / 2019 / Abstract WP47: Efficacy and safety of nimodipin during mechanical thrombectomy / Stroke 50(Suppl 1):AWP47

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