Introduction

Cocaine through multifactorial pathogenetic mechanisms causes small and large vessel occlusions (LVO) leading to acute ischemic stroke. The optimal treatment for cocaine related LVO remains unknown. Mechanical thrombectomy (MT) poses a unique challenge, and successful MT are not widely reported.

Material and Methods

We report three patients with no other risk factors and a common history of cocaine metabolites found on presentation drug screen who underwent MT for MCA occlusions with subsequent failed recanalization or vessel re-occlusion due to persistent thrombosis and severe vasospasm.Two patients initially had good revascularization but then developed severe vasospasm and reoccluded, and the remaining patient had persistent severe distal vasospasm. Rescue therapy either with balloon angioplasty with stent placement or intraarterial vasodilator was used in all patients and was ineffective. All patient had large hemispheric strokes and developed malignant cerebral edema requiring hemicraniectomy in two of them. We also did literature review and summarized previously reported cases of cocaine associated vasospasm in MT and other endovascular procedures.

Conclusion

In this case series, cocaine induced vasospasm contributed to unsuccessful recanalization and reocclusion in patients undergoing MT with poor outcomes. Further studies are needed to ascertain strategies for improved outcomes in patients with LVO related to cocaine use.

中文翻译：

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机械血栓切除术可卡因相关的急性缺血性卒中大血管闭塞：小病例系列和文献综述。

介绍

可卡因通过多种因素的致病机制引起大小血管闭塞（LVO），导致急性缺血性中风。可卡因相关LVO的最佳治疗方法仍然未知。机械血栓切除术（MT）提出了一个独特的挑战，成功的MT尚未广泛报道。

材料与方法

我们报告了3例没有其他危险因素且在可疑药物筛查中发现可卡因代谢物的共同病史的患者，他们因持续的血栓形成和严重的血管痉挛而接受MT进行MCA闭塞治疗，随后因通畅性血栓形成和严重的血管痉挛而导致再通失败或血管再闭塞.2例患者最初的血运重建良好但随后发生了严重的血管痉挛并再次闭塞，其余患者持续存在严重的远端血管痉挛。所有患者均采用气囊血管成形术和支架置入术或动脉内血管扩张剂进行抢救治疗，但均无效。所有患者均发生大的半球性卒中，并发展为恶性脑水肿，其中有两个需要半脑切除术。我们还进行了文献回顾并总结了先前报道的MT和其他血管内手术中可卡因相关血管痉挛的病例。

结论

在这个病例系列中，可卡因诱发的血管痉挛导致结节不良的MT患者重新通畅和重新闭塞。需要进一步研究以确定与可卡因使用有关的LVO患者改善预后的策略。