nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2022-4-44-50nnp-1860Research ArticleCLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯA clinical case of mechanical recanalization of recurrent cerebral embolism in the hyperacute period of ischemic stroke with hemorrhagic transformationКлинический случай механической реканализации повторной церебральной эмболии в острейшем периоде ишемического инсульта, протекавшего с геморрагической трансформациейhttps://orcid.org/0000-0002-8162-2359МуртазалиеваД. М.MurtazalievaD. M.

Джавгарат Магомедовна Муртазалиева127644, Москва, ул. Лобненская, 10

Dzhavgarat Magomedovna Murtazalieva127644, Moscow, Lobnenskaya St., 10

djana.murt@gmail.comhttps://orcid.org/0000-0002-5563-4890ЗакарьяеваА. Р.ZakaryaevaA. R.

127644, Москва, ул. Лобненская, 10

127644, Moscow, Lobnenskaya St., 10

https://orcid.org/0000-0002-4608-302XСтруценкоМ. В.StrutsenkoM. V.

127644, Москва, ул. Лобненская, 10

127644, Moscow, Lobnenskaya St., 10

https://orcid.org/0000-0002-2659-1211ОсиповИ. Ю.OsipovI. Y.

127644, Москва, ул. Лобненская, 10

127644, Moscow, Lobnenskaya St., 10

https://orcid.org/0000-0001-8277-2255ШогеновЗ. С.ShogenovZ. S.

127644, Москва, ул. Лобненская, 10

127644, Moscow, Lobnenskaya St., 10

ГБУЗ г. Москвы «Городская клиническая больница им. В.В. Вересаева Департамента здравоохранения г. Москвы»РоссияCity Clinical Hospital named after V.V. Veresaev, Department of Health of MoscowRussian Federation2022230820221444450Copyright © Murtazalieva D.M., Zakaryaeva A.R., Strutsenko M.V., Osipov I.Y., Shogenov Z.S., 20222022Муртазалиева Д.М., Закарьяева А.Р., Струценко М.В., Осипов И.Ю., Шогенов З.С.Murtazalieva D.M., Zakaryaeva A.R., Strutsenko M.V., Osipov I.Y., Shogenov Z.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1860

Currently, there is no single algorithm for the treatment of acute tandem occlusion of the internal carotid artery (ICA) and middle cerebral artery (MCA). The article presents the clinical case of ischemic stroke, which developed 10 days after the first ischemic episode with hemorrhagic transformation. As reperfusion therapy, thrombectomy from the M1 segment of the left MCA and simultaneous stenting of the left ICA were performed. The use of dual antiplatelet therapy at a loading dose in this clinical case was justified by the risk of stent thrombosis, but this increased the risk of recurrent hemorrhagic transformation. Follow-up of the patient for 90 days after this vascular event showed a favorable clinical outcome without hemorrhagic complications. The presented clinical case is extremely rare and shows one of the possible approaches in the management of patients with tandem lesions of the brachiocephalic arteries with a history of intracranial hemorrhagic complications. To develop a unified algorithm for managing acute tandem occlusion in recurrent ischemic strokes, more observations are needed.

В настоящее время не существует единого алгоритма лечения острой тандемной окклюзии внутренней сонной артерии (ВСА) и средней мозговой артерии (СМА). В статье представлено наблюдение пациентки с ишемическим инсультом, который развился спустя 10 дней после первого ишемического эпизода, проходившего с геморрагической трансформацией. В качестве реперфузионной терапии проведены тромбэктомия из сегмента М1 левой СМА и одномоментное стентирование левой ВСА. Применение двойной антиагрегантной терапии в нагрузочной дозе в данном клиническом случае было обосновано риском тромбоза стента, однако это повышало риск повторной геморрагической трансформации. Наблюдение за пациенткой в течение 90 дней после данного сосудистого события показало благоприятный клинический исход без геморрагических осложнений. Приведенный клинический случай относится к крайне редким и показывает один из возможных подходов в ведении пациентов с тандемным поражением брахиоцефальных артерий при внутричерепных геморрагических осложнениях в анамнезе. Для разработки единого алгоритма ведения острой тандемной окклюзии при повторных ишемических инсультах необходимо большее количество наблюдений.

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The authors declare that there are no conflicts of interest present.