Mechanical Thrombectomy Using a Stent Retriever with an Intermediate Catheter for Partially Occluded Middle Cerebral-artery Fenestration.

Mechanical Thrombectomy Using a Stent Retriever with an Intermediate Catheter for Partially Occluded Middle Cerebral-artery Fenestration.:

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Mechanical Thrombectomy Using a Stent Retriever with an Intermediate Catheter for Partially Occluded Middle Cerebral-artery Fenestration.

World Neurosurg. 2020 Mar 26;:

Authors: Liao G, Zhang Z, Che X, Liang H

Abstract

BACKGROUND: Middle cerebral artery fenestration (MCAF) is a rare vascular variant of the middle cerebral artery (MCA). When this occlusion occurs, it presents challenges to identification and recanalization. In this paper, we describe a patient with a partially occluded MCAF who was successfully recanalized via mechanical thrombectomy (MT) using a stent retriever with an intermediate catheter (IC).

CASE DESCRIPTION: A 65-year-old man with a history of ischemic stroke and homocysteinemia presented with dysarthria and expressive aphasia 14 hours after symptom onset. His National Institutes of Health Stroke Scale (NIHSS) score was 12/42. Non-contrast computed tomography (NCCT) scan revealed encephalomalacia in the left cerebral hemisphere. Catheter angiography displayed left-internal carotid-artery orifice and M1 segment sub-occlusion. The primary diagnosis was acute ischemic stroke. MT was performed by passing a stent retriever through the subtotal occlusive segment of the left MCA (L-MCA).After angiography was completed, reperfusion was considered successful, with modified Thrombolysis in Cerebral Infarction grade (mTICI) 3. The fenestration was discovered in the middle-to-distal part of the L-MCA M1 segment where the thrombus was located. After 3 days, magnetic resonance imaging (MRI) showed much ischemic damage to the left hemicerebrum area. The day after endovascular treatment, the patient's neurological deficit recovered to its pre-onset state. At 6 months' follow-up, stroke had not recurred, and the patient is living independently with a modified Rankin scale score (mRS) of 1.

CONCLUSIONS: MT may be feasible and safe in MCAF occlusion.

PMID: 32224267 [PubMed - as supplied by publisher]