J Cerebrovasc Endovasc Neurosurg.  2019 Mar;21(1):33-39. 10.7461/jcen.2019.21.1.33.

Successful Mechanical Thrombectomy Using Solumbra Technique In a 35-year-old Man With Achondroplasia: a case report

• Cho JS
• Kim SU
• Kim HJ
• Yang JH
• Lee IW
• Lee HJ

• KMID: 2465013
• DOI: http://doi.org/10.7461/jcen.2019.21.1.33

Abstract

BACKGROUND
Achondroplasia is one of the most common types of dwarfism and is inherited as an autosomal dominant disease. The patients with achondroplasia suffer from various complications such as craniofacial, central nervous system, spinal, respiratory and cardiac anomalies. CASE DESCRIPTION: We report a case of a 35-year-old man with achondroplasia who visited the emergency room with right hemiplegia and aphasia within 6 hours after onset. An Initial CT angiography showed the total occlusion of a left internal cerebral artery due to the thrombus. We treated the patient with endovascular thrombectomy using "Solumbra technique" with balloon guiding catheter. The procedure was successful and result was completely recanalized with Thrombolysis in Cerebral Infarction (TICI) scale 3 and the weakness also improved from grade II to grade IV.
CONCLUSION
Acute ischemic stroke patients with achondroplasia could be treated with mechanical thrombectomy.

Keyword

Achondroplasia; cerebral infarction; thrombectomy

MeSH Terms

Achondroplasia*
Adult*
Angiography
Aphasia
Catheters
Central Nervous System
Cerebral Arteries
Cerebral Infarction
Dwarfism
Emergency Service, Hospital
Hemiplegia
Humans
Stroke
Thrombectomy*
Thrombosis

Figure

• 

  Fig. 1 (A) A 35-year-old man with achondroplasia measuring 130 cm in height visited ER with aphasia and right hemiplegia (photograph in the intervention room for the procedure). (B) Abdominal CT showed severe inguinal hernia that intestines migrated into the scrotum. (C) Initial non-enhanced CT demonstrated no evidence of hemorrhage or definite low density. (D) CT angiogram (coronal view) showed left distal ICA occlusion due to a thrombus (white arrow) and only a slight anterotemporal flow was observed, whereas ipsilateral proximal A1 and MCA distal blood flow were not detected.

• 

  Fig. 2 To determine the use and sizes of thrombectomy devices, the initial CT angiogram was checked the normal diameters of contralateral MCA (A), ICA (B), and CCA (C), and we measured as 3.0mm, 4.2mm, and 8.2mm, respectively.

• 

  Fig. 3 (A) Diagnostic ICA angiogram showed anterotemporal artery flow but ACA and MCA flow was not detected because of thrombus (white arrow). (B) During waiting 3 min after deploying the Trevo XP 6 × 25 mm (white arrow) with AXS Catalyst ™6 (blackarrow) at the first trial, distal MCA flow was weakly observed, (arrow heads) but no ACA flow was detected due to thrombus in the stent. (C) After second thrombectomy trial, both ACA and MCA flow was completely reperfused with TICI 3. (black arrow) (D) Some thrombi were obtained from aspirating the AXS Catalyst ™6, but no clots were found in retriever stent and balloon guiding catheter.

• 

  Fig. 4 After 3 days post procedure, there was no definite hemorrhage or low density in left MCA territory on enhanced brain CT (A) and the volume rendered reconstruction also showed intact left MCA (B). Three months later, follow-up MR angiography revealed well maintained completely reperfused MCA (white arrow) (C).

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