Key result
Mechanical thrombectomy resolves left MCA occlusion during catheter ablation, dropping NIHSS to 0.
Case Report (n=1)
No
Highlights the risk of stroke from aortic arch plaques during transarterial left ventricular ablation and the effectiveness of prompt mechanical thrombectomy.
Prompt thrombectomy may aid periprocedural stroke recovery during ablation; case reports leave open generalizability and prevention strategies.
症例は74歳男性．血圧低下を伴う心室頻拍発作のため前医に搬送され，アブレーション目的に当院循環器内科へ紹介された．アブレーションは局所麻酔下に実施され，カテーテルを経動脈的に左室内に挿入した直後に失語が出現し，当科紹介となった．脳血管撮影を実施したところ，左中大脳動脈M1 distalの閉塞を認めた．Combined techniqueによる血栓回収術を実施し，1 passでthrombolysis in cerebral infarction （TICI） Grade 3の再開通を得た．術直後より症状は改善した．塞栓子の病理所見はフィブリン血栓で，その後実施した経食道心エコーおいて，大動脈弓部に可動性のあるプラークを認めた．左室内膜アブレーションに際しては，アクセスルートの評価を含めた脳卒中リスクについて，循環器内科との共有と連携が重要であると考える．
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Kanamori et al. (2023) conducted a case report in Paroxysmal ventricular tachycardia and left middle cerebral artery occlusion (n=1). Mechanical thrombectomy was evaluated on Thrombolysis in cerebral infarction (TICI) score and NIHSS score. Mechanical thrombectomy successfully achieved TICI Grade 3 recanalization and improved the NIHSS score from 19 to 0 in a patient who developed left middle cerebral artery occlusion during catheter ablation.
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