Extracranial internal carotid artery vasospasm during thrombectomy

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Mechanical thrombectomy using stent retrievers is a standard treatment for acute ischemic stroke.
• Intracranial and extracranial vasospasm are known complications following neurovascular procedures.

Observation:

• A 47-year-old male developed severe, long-segment extracranial internal carotid artery vasospasm after mechanical thrombectomy for acute cerebral ischemia.
• The vasospasm was attributed to mechanical irritation from a stent retriever during the procedure.

Findings:

• The patient experienced worsening aphasia concurrent with the development of cervical vasospasm.
• Intracatheter nicardipine infusion successfully improved the vasospasm.

Implications:

• This case highlights the risk of stent retriever-induced vasospasm in the extracranial internal carotid artery, particularly in patients with pre-existing narrow vessels.
• Consideration of alternative guiding catheters (e.g., smaller diameter or distal placement) may mitigate this risk and prevent vessel wall irritation.