Repeated Mechanical Thrombectomy in the Same Intracranial Artery Segment

Area of Science:

• Neurology
• Interventional Neuroradiology
• Cardiovascular Medicine

Background:

• Acute ischemic stroke management often involves mechanical thrombectomy for large vessel occlusions.
• Recurrent intracranial artery occlusions pose a clinical challenge, particularly within the same arterial segment.
• Atrial fibrillation and mechanical heart valves are known risk factors for thromboembolic events.

Observation:

• A patient with atrial fibrillation and a mechanical mitral valve experienced two separate acute ischemic strokes.
• Both strokes involved an occlusion in the proximal right middle cerebral artery segment.
• The patient underwent mechanical thrombectomy using a stent retriever for both occlusions.

Findings:

• Successful revascularization was achieved in both instances of mechanical thrombectomy.
• The same intracranial artery segment required intervention twice within a 58-day period.
• This represents the first reported case of repeated mechanical thrombectomy in the identical intracranial artery segment using stent retrievers.

Implications:

• Repeated mechanical thrombectomy in the same intracranial artery segment is a viable treatment option for select patients.
• Stent retriever technology demonstrates efficacy in managing recurrent occlusions.
• Further research is warranted to understand the mechanisms and optimal management strategies for recurrent stroke in the same arterial territory.