急性基底动脉闭塞血管内机械取栓术中支架回收失败1例
Chinese Journal of Interventional Imaging and Therapy（2019）
Abstract
患者男,71岁,因“突发意识不清3h”入院.急查头颅CT未见明确出血灶,双侧基底核区见腔隙性脑梗死病灶;美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分38分,Alberta卒中项目早期CT评分10分;经静脉溶栓后未见好转.脑血管造影:左椎动脉V1段次全闭塞(图1A);基底动脉全程不显影,考虑闭塞(图1B).行左椎动脉V1段闭塞球囊扩张术,将导引导管超选入左椎动脉V2段,造影示基底动脉远端闭塞.以微导丝携带微导管穿过闭塞段,造影证实导管位于真腔内(图1C),乃释放Solitaire AB支架(4 mm×20 mm)1枚,复查造影闭塞段未见前向血流(图1D);5 min后尝试回撤支架,因阻力较大难以回撤,试以推送微导管回收支架并行机械碎栓,同时推注盐酸替罗非班约10 ml、尿激酶5万U,造影示基底动脉远端无明显前向血流,反复尝试回收支架仍未成功,遂将支架原位解脱.
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