题目：

经后交通动脉机械取栓治疗同时累及前、后循环的急性大血管闭塞性缺血性卒中

Mechanical thrombectomy via the posterior communication artery for acute ischemic stroke with large vessel occlusion involving the anterior and posterior circulation simultaneously

摘要：

77岁男性，发现言语不能、右侧肢体无力6小时就诊。CTA及CTP检查提示左侧颈内动脉及基底动脉均闭塞，行机械取栓治疗。DSA证实了颈内动脉和基底动脉闭塞，然而，在取栓过程中发现此次病变为基底动脉尖闭塞，同时累及了左侧后交通动脉，而颈内动脉为慢性闭塞。经后交通动脉机械取栓后，同时恢复了前循环和后循环的血流。术后临床和影像随访也证实了术中判断是正确的。

A 77-year-old male patient was found being suffered from slurred speech and right limbs weakness for 6 hours. The results of CT angiography and CT perfusion indicated that both of the left internal carotid artery (ICA) and basilar artery (BA)were occlusions. Mechanical thrombectomy was performed for this patient. The digital subtraction angiography confirmed the lesions of the left ICA and BA. However, we finally found that the offending vessel was the occlusion of BA, which was also involving the left posterior communication artery, whereas the left ICA was chronic occlusion. Finally, the anterior and posterior circulation vessels successfully recovered reperfusion through aspiration thrombectomy combined with stent-retriever thrombectomy via the posterior communication artery.The following clinical and imaging results had confirmed the correction of judgment made during the operational process. 

这是一例非常规路径、跨循环取栓的案例，病例关键难点在于术者对影像能否进行快速准确判读。

当遇到多血管受累的情况时，需要术者注意对影像信息进行更加全面仔细的研判，同时注意不要忽略既往患者影像资料及外院影像的调阅，取栓前必须进行完善快速的脑血管造影评价，鉴别各类不同病因造成的颅内大血管闭塞的影像特征，制定相应的手术入路策略。同时术中应在每一步操作后再次确认自己的预判是否存疑，及时调整手术方案。

如判断确实多血管床同时栓塞的可能性更大时，治疗顺序应该结合不同血管区域手术难易程度，以先易后难的顺序开通多个闭塞血管。

跨循环取栓是一种非常规技术手段，既往仅有少量的病案报告。由于前后交通动脉管径、角度、走行等条件的限制，跨循环取栓不能作为首选的技术方法，可在部分困难案例中谨慎选择使用。