Mechanical thrombectomy through a 'carotid-carotid bypass'

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Acute ischemic stroke management often involves mechanical thrombectomy for large vessel occlusions.
• Carotid-carotid bypass presents a unique anatomical challenge for accessing intracranial circulation.

Observation:

• An elderly patient presented with acute right-sided weakness and aphasia due to a left middle cerebral artery (MCA) occlusion with a large penumbra.
• The patient had a history of carotid-carotid bypass, complicating standard endovascular approaches.

Findings:

• Despite the technical challenge, a guiding catheter was navigated coaxially across the bypass to access the intracranial circulation.
• Successful mechanical thrombectomy achieved complete recanalization and reperfusion.
• The patient experienced significant neurological recovery post-procedure.

Implications:

• This case demonstrates the feasibility of mechanical thrombectomy in patients with carotid-carotid bypass.
• It emphasizes that complex vascular anatomy should not deter timely stroke intervention.
• Operator experience and technical adaptability are crucial for managing rare thrombectomy scenarios.