カワシマ　アキツグ   Kawashima Akitsugu   川島　明次    所属   医学部 医学科（東京女子医科大学病院）    職種   准教授
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Extracranial internal carotid artery vasospasm during thrombectomy.
掲載誌名	正式名：The neuroradiology journal 略　 称：Neuroradiol J ISSNコード：23851996/19714009
掲載区分	国内
巻・号・頁	31(3),pp.313-316
著者・共著者	Miura Isamu†, Kawashima Akitsugu, Hayashi Masataka, Tanda Akane, Ishikawa Tomomi, Kawamata Takakazu
担当区分	2nd著者
発行年月	2018/06
概要	The use of a stent retriever increases the risk of intracranial vasospasm. Here, we report the case of a man who developed severe vasospasm in a long segment of the extracranial internal carotid artery after mechanical irritation by a stent retriever inserted for the treatment of acute cerebral ischemia. A 47-year-old right-handed man presented with sudden-onset right-sided weakness and difficulty speaking. The patient's National Institutes of Health Stroke Scale score was 6 and he had an Alberta Stroke Program Early Computed Tomography Score of 9. The patient was started on intravenous alteplase therapy, and an acute thrombectomy was performed. Left internal carotid digital subtraction angiography showed narrowing of the left common and internal carotid arteries and occlusion of the proximal left M1 segment of the middle cerebral artery. A stent retriever was retracted into a guiding catheter placed at the left carotid bulb under continuous suction. Recanalization of the middle cerebral artery was not achieved and there was significant narrowing in a long segment of the extracranial internal carotid artery associated with exacerbation of the patient's aphasia. The cervical vasospasm improved after nicardipine infusion via the catheter. We encountered vasospasm in a long segment of the extracranial internal carotid artery after mechanical irritation by a stent retriever. If a stent retriever is used in a patient with a narrow extracranial internal carotid artery, consideration should be given to using a Penumbra or smaller guiding catheter located in the distal internal carotid artery to prevent irritation to the cervical vessel wall.
DOI	10.1177/1971400917731118
PMID	28895453