Acute large vessel occlusion is a common cause of acute ischemic stroke (AIS), with high rates of disability and lethality. The incidence of tandem occlusion of the internal carotid artery accounts for about 20% of pa...Acute large vessel occlusion is a common cause of acute ischemic stroke (AIS), with high rates of disability and lethality. The incidence of tandem occlusion of the internal carotid artery accounts for about 20% of patients with large vessel occlusion of the anterior circulation in acute ischemic stroke. The low rate of recanalization by intravenous thrombolysis in AIS due to internal carotid artery tandem occlusion, the poor establishment of collateral circulation within a short time, and the complex pathogenesis often suggest a poor prognosis for patients. Mechanical thrombectomy (MT) is beneficial for the opening of intracranial large vessel occlusion with internal carotid artery tandem occlusion, there are many problems regarding the emergency management of carotid artery occlusion or stenosis after mechanical thrombectomy, and there are currently no standardized treatment recommendations;The sequential approach to the management of carotid tandem occlusion, the timing of carotid stenting, and the use of antiplatelet agents remain controversial. The current state of research on carotid tandem occlusion is analyzed in the literature to promote clinical understanding of endovascular treatment for patients with acute ischemic stroke due to carotid tandem occlusion.展开更多
Tandem internal carotid and middle cerebral artery occlusion after carotid dissection predicts poor outcome after systemic thrombolysis. Current treatments include the use of endovascular carotid stenting, which carri...Tandem internal carotid and middle cerebral artery occlusion after carotid dissection predicts poor outcome after systemic thrombolysis. Current treatments include the use of endovascular carotid stenting, which carries with it a high risk of propagating further embolic events and worsening the dissection. New strategies for avoiding the aforementioned side-effects include recanalization using cross-collaterals for delivery of intra-lesional tissue plasminogen activator(t PA). We present two cases that provide further support for this novel approach. Both patients presented with a National Institute of Health Stroke Scale of 20, received intra-arterial t PA via cross-collateralization, and made full recoveries without the need for stenting.展开更多
Multiple intracranial aneurysms account for 14%-35%of all intracranial aneurysms.Their incidence rate is significantly increased in women,patients with connective tissue disease,and patients with a family history of s...Multiple intracranial aneurysms account for 14%-35%of all intracranial aneurysms.Their incidence rate is significantly increased in women,patients with connective tissue disease,and patients with a family history of subarachnoid hemorrhage.Among them,tandem aneurysms are located on the same parent artery and in close proximity to each other.The LEO stent is a self-expanding nickel-titanium braided stent for intracranial vascularization,which is a delivery system that is easy to navigate and position precisely.This case report describes a 68-year-old female patient who was presented with the chief complaints of dizziness for more than a month upon admission to the First Affiliated Hospital,Zhejiang University,School of Medicine.The cerebral angiography established right vertebral artery occlusion,V4 segment of left vertebral artery dissection with two tandem aneurysms,and bilateral internal carotid artery cavernous sinus segment dissection aneurysm.Therefore,we opted to use the LEO stent semi-release assisted coil embolization to treat the vertebral artery V4 segment tandem aneurysms.Some problems encountered during the operation were also considered and discussed.展开更多
文摘Acute large vessel occlusion is a common cause of acute ischemic stroke (AIS), with high rates of disability and lethality. The incidence of tandem occlusion of the internal carotid artery accounts for about 20% of patients with large vessel occlusion of the anterior circulation in acute ischemic stroke. The low rate of recanalization by intravenous thrombolysis in AIS due to internal carotid artery tandem occlusion, the poor establishment of collateral circulation within a short time, and the complex pathogenesis often suggest a poor prognosis for patients. Mechanical thrombectomy (MT) is beneficial for the opening of intracranial large vessel occlusion with internal carotid artery tandem occlusion, there are many problems regarding the emergency management of carotid artery occlusion or stenosis after mechanical thrombectomy, and there are currently no standardized treatment recommendations;The sequential approach to the management of carotid tandem occlusion, the timing of carotid stenting, and the use of antiplatelet agents remain controversial. The current state of research on carotid tandem occlusion is analyzed in the literature to promote clinical understanding of endovascular treatment for patients with acute ischemic stroke due to carotid tandem occlusion.
文摘Tandem internal carotid and middle cerebral artery occlusion after carotid dissection predicts poor outcome after systemic thrombolysis. Current treatments include the use of endovascular carotid stenting, which carries with it a high risk of propagating further embolic events and worsening the dissection. New strategies for avoiding the aforementioned side-effects include recanalization using cross-collaterals for delivery of intra-lesional tissue plasminogen activator(t PA). We present two cases that provide further support for this novel approach. Both patients presented with a National Institute of Health Stroke Scale of 20, received intra-arterial t PA via cross-collateralization, and made full recoveries without the need for stenting.
文摘Multiple intracranial aneurysms account for 14%-35%of all intracranial aneurysms.Their incidence rate is significantly increased in women,patients with connective tissue disease,and patients with a family history of subarachnoid hemorrhage.Among them,tandem aneurysms are located on the same parent artery and in close proximity to each other.The LEO stent is a self-expanding nickel-titanium braided stent for intracranial vascularization,which is a delivery system that is easy to navigate and position precisely.This case report describes a 68-year-old female patient who was presented with the chief complaints of dizziness for more than a month upon admission to the First Affiliated Hospital,Zhejiang University,School of Medicine.The cerebral angiography established right vertebral artery occlusion,V4 segment of left vertebral artery dissection with two tandem aneurysms,and bilateral internal carotid artery cavernous sinus segment dissection aneurysm.Therefore,we opted to use the LEO stent semi-release assisted coil embolization to treat the vertebral artery V4 segment tandem aneurysms.Some problems encountered during the operation were also considered and discussed.
