J Cerebrovasc Endovasc Neurosurg.  2022 Jun;24(2):172-175. 10.7461/jcen.2021.E2021.07.013.

Salvage treatment with stenting and temporary balloon occlusion for subarachnoid hemorrhage after stent retrieval following acute proximal M3 occlusion treatment

• Kim H
• Jin SC
• Lee H

• KMID: 2531661
• DOI: http://doi.org/10.7461/jcen.2021.E2021.07.013

Abstract

Procedure-related subarachnoid hemorrhage (SAH) after mechanical thrombectomy is known to be a clinically benign presentation. However, the treatment in the presence of definite contrast leakage without vessel rupture is controversial. Here, we report a case in which a salvage technique was performed for procedure-related SAH after mechanical thrombectomy for a proximal M3 occlusion.
A 56-year-old female patient presented with global aphasia and right hemiparesis within 2 hours after symptom onset. The initial National Institute of Health Stroke Scale score of the patient was 18 points, and Computed tomography (CT) angiography showed that the superior division of the left middle cerebral artery (MCA) was occluded. We decided to treat the patient with mechanical thrombectomy. Control angiography showed a left proximal M3 occlusion. We performed mechanical thrombectomy with a partially deployed technique using a Trevo 3 mm stent (Stryker). Control angiography showed recanalization of the occluded vessel but contrast leakage after stent retrieval. We decided to treat the lesion presenting with contrast leakage with stenting using a Neuroform Atlas 3 mm stent (Stryker). Serial control angiography continued to show contrast leakage of the recanalized artery. We decided to treat the lesion with temporary balloon occlusion using a Scepter C balloon catheter (MicroVention). The patient recovered and had a modified Rankin scale score at discharge of 0.
Given the results of our case, stenting and subsequent repeat temporary balloon occlusion should be considered for SAH with contrast leakage after mechanical thrombectomy, as spontaneous cessation of the arterial bleeding is unlikely.

Keyword

Thrombectomy; Complication; Subarachnoid hemorrhage

Figure

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  Fig. 1. (A) Left proximal M3 occlusion was showed on left internal carotid angiography. The thrombi was showed in microangiogram (arrow head). (B) Stent retrieval (Trevo 3 mm (Stryker)) was placed in M3. (C) Contrast leakage was showed at proximal of the lesion on control angiography after stent retrieval (arrow head). (D) Serial control angiography showed persistence of the contrast leakage after stent deployment (arrow head). (E) Temporary balloon occlusion was placed at proximal artery of the lesion. (F) There was none of contrast leakage in the final angiogram.

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  Fig. 2. Computed tomography showed a subarachnoid hemorrhage in left sylvian fissure.

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