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Interventional treatment for acute cerebral infarction with large vessel occlusion combined with aortic arch
WenSheng Zhang1, WeiFang Xing, MinZhen Zhu
1Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Guangdong Province, China.
Insights
This case report details a rare instance of acute cerebral infarction in an adult with interrupted aortic arch. Emergency radial artery thrombectomy successfully treated the large vessel occlusion, highlighting a feasible intervention for this complex condition.
Area of Science:
- Cardiovascular Research
- Neurology
- Interventional Cardiology
Background:
- Interrupted aortic arch is a rare congenital vascular malformation typically presenting in childhood.
- Survival to adulthood necessitates extensive collateral circulation; severe complications like stroke are uncommon.
- This is the first reported case of interventional treatment for acute cerebral infarction with large vessel occlusion in an adult with interrupted aortic arch.
Observation:
- A 55-year-old male with atrial fibrillation and smoking history presented with acute stroke symptoms.
- Brain imaging confirmed a large cerebral infarction; endovascular intervention was initiated.
- Aortic arch interruption was suspected, and the approach was converted to transradial access.
Findings:
- Successful recanalization of the occluded right internal carotid artery was achieved via thrombus aspiration.
- The patient demonstrated excellent functional recovery, with a modified Rankin Scale score of 0 at 3 months and 1 at 1 year.
- Despite successful stroke intervention, the patient declined further treatment for the underlying aortic arch interruption.
Implications:
- Acute cerebral infarction with large vessel occlusion can occur in adults with interrupted aortic arch.
- Emergency thrombectomy using the transradial artery approach is a viable treatment option.
- This case expands the understanding of managing complex vascular anomalies presenting with neurological emergencies.
Rationale:
Aortic arch interruption is a type of congenital vascular malformation that is often observed in childhood. Most children die of congestive heart failure due to rapid deterioration. Children can only survive to adulthood if they have extremely rich collateral circulation. Cases of acute cerebral infarction with large vessel occlusion receiving interventional treatment in adult patients with interrupted aortic arch have not been reported.
Patient Concerns:
A 55-year-old man with a history of atrial fibrillation and smoking but without a family history of stroke was admitted to our hospital with a 5-hour history of left limb weakness and speech difficulties.
Diagnoses:
Emergency brain computed tomography showed a large cerebral infarction in the right frontal temporal parietal lobe. He was suspected to have aortic arch interruption in the early stage of endovascular interventional therapy through the femoral artery approach, and was converted to the transradial artery pathway. The aortic arch was disconnected, and the right internal carotid artery was occluded.
Interventions:
Considering the possibility of cardiogenic embolism, a middle catheter was used for thrombus aspiration of the right internal carotid artery. After removal of the dark red thrombus was removed, the right internal carotid artery was successfully recanalized.
Outcomes:
The patient recovered well after the operation. However, the patient and his family refused further treatment for aortic arch interruption. The modified Rankin Scale score was 0 at 3 months and 1 year of follow-up which meant that he recovered quite well.
Lessons:
Adult patients with acute cerebral infarction with large vessel occlusion are rarely complicated with aortic arch interruption, and emergency thrombectomy via the radial artery approach is feasible.
