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Successful Cross-circulation Stent-Retriever Embolectomy Through Posterior Communicating Artery for Acute MCA
Seul Kee Kim1, Byung Hyun Baek2, Tae Wook Heo2
1Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, Korea.
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.
Insights
This study presents the first successful use of stent-retriever embolectomy via a cross-circulation approach for acute middle cerebral artery occlusion. This technique offers a new option for stroke patients with complex internal carotid artery occlusions.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Acute ischemic stroke involving the middle cerebral artery (MCA) secondary to embolism in patients with chronic ipsilateral internal carotid artery (ICA) occlusion is a rare clinical scenario.
- Established treatments like intra-arterial thrombolysis and aspiration thrombectomy via collateral pathways have been reported.
- Stent-retriever embolectomy using a cross-circulation approach has not been previously documented.
Purpose of the Study:
- To report the first successful case of stent-retriever embolectomy for acute MCA occlusion.
- To demonstrate the feasibility of the cross-circulation technique in a patient with chronic ICA occlusion.
- To highlight the use of the Trevo XP ProVue stent-retriever in this specific clinical context.
Main Methods:
- A patient with acute MCA stroke and chronic ipsilateral ICA occlusion was treated.
- A stent-retriever embolectomy was performed using a cross-circulation technique.
- The procedure utilized the patent posterior communicating artery (PComA) as an alternative collateral pathway.
- The Trevo XP ProVue stent-retriever was employed for clot retrieval.
Main Results:
- Successful retrieval of the embolic occlusion in the MCA was achieved.
- The cross-circulation approach via the PComA proved to be a feasible and effective strategy.
- The patient's acute MCA stroke was treated successfully using stent-retriever embolectomy.
Conclusions:
- Stent-retriever embolectomy via a cross-circulation approach is a viable treatment option for acute MCA occlusion in patients with chronic ipsilateral ICA occlusion.
- This technique, utilizing collateral pathways like the PComA, expands treatment possibilities for complex stroke cases.
- The Trevo XP ProVue stent-retriever is effective in this challenging scenario.
