Neurointervention.  2016 Mar;11(1):55-58. 10.5469/neuroint.2016.11.1.55.

Successful Cross-circulation Stent-Retriever Embolectomy Through Posterior Communicating Artery for Acute MCA Occlusion by Using Trevo XP ProVue

• Kim SK
• Baek BH
• Heo TW
• Yoon W

• KMID: 2155721
• DOI: http://doi.org/10.5469/neuroint.2016.11.1.55

Abstract

Acute ischemic stroke due to embolic occlusion of the middle cerebral artery (MCA) in patients with chronic ipsilateral internal carotid artery (ICA) occlusion is quite rare. Several previous reports demonstrated that intra-arterial (IA) thrombolytic therapy or aspiration thrombectomy using the cross-circulation technique via an alternative collateral pathway is feasible in acute stroke patients with an unfavorable direct route to the occluded sites. However, stent-retriever embolectomy via the cross-circulation approach has not been reported in the literature. The present paper reports the first case of successful stent-retriever embolectomy for acute MCA occlusion via the patent posterior communicating artery (PComA) by using Trevo XP ProVue stent-retriever in a patient with acute MCA stroke and chronic occlusion at the origin site of the ipsilateral ICA.

Keyword

Cross-circulation; Acute ischemic stroke; Stent-retriever embolectomy

MeSH Terms

Arteries*
Carotid Artery, Internal
Embolectomy*
Humans
Middle Cerebral Artery
Stroke
Thrombectomy
Thrombolytic Therapy

Figure

• 

  Fig. 1 Brain images from a 57-yearold male patient presented with left hemiparesis and dysarthria.A. Diffusion weighted MRI shows restricted diffusion within the right basal ganglia. B. 3D time-of-flight MRA shows a complete occlusion in the mid M1 segment of the right MCA (arrow). Absent flow-related enhancement of the bilateral ICAs is also present. Anterior cerebral circulation is supplied by the basilar artery via the right patent PComA (arrowhead) and left persistent trigeminal artery (arrow outline). C. Lateral right common carotid artery angiogram shows a chronic occlusion at the origin site of the right ICA with a small stump (arrow). D. Right vertebral artery angiogram demonstrating an occlusion in the mid M1 segment of the right MCA (arrow). E and F. A 4 × 20 mm Trevo XP ProVue retriever stent is deployed over the whole length of the thrombus in the right MCA through the right PComA (white arrow). Stent has three radiopaque distal markers (black arrowheads). Anterior-posterior and lateral vertebral artery angiogram following stent deployment, shows immediate distal flow of the right MCA. Note the filling defect in the M1 segment representing a trapped thrombus within the stent struts (black arrows). White arrowhead indicates the left persistent trigeminal artery. G. Angiogram after stent retrieval embolectomy shows complete revascularization in the right MCA territory. H. Photograph demonstrates a large red clot retrieved with a Trevo stent.

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