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Transbrachial Mechanical Thrombectomy for Acute Ischemic Stroke in Marfan's Syndrome: A Case Report
Tsuyoshi Shimizu1, Makoto Sakamoto2, Hideki Kamitani1
1Department of Neurosurgery, Tottori Prefectural Kousei Hospital, Kurayoshi, Tottori, Japan.
Objective:
Marfan's syndrome (MFS) is a systemic connective tissue disorder with autosomal dominant inheritance. Cardiovascular complications of MFS such as aortic root or valve disease and aortic aneurysm or dissection are potential cause of access route problems of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Here, we report a case of a patient with MFS who underwent MT for AIS.
Case Presentation:
A 58-year-old woman with MFS presented with a sudden onset of consciousness disturbance and right hemiparesis, and was referred to our hospital. After the infusion of tissue plasminogen activator, CTA showed a type III arch in the aortic arch and severe tortuosity of the thoracoabdominal aorta; thus, angiography was performed using the transbrachial approach. Left common carotid angiogram showed complete recanalization of the left middle cerebral artery. On the sixth day, the patient presented a sudden consciousness disturbance and left hemiparesis. MRA showed right internal carotid artery occlusion. MT was performed by the transbrachial approach, and complete recanalization was achieved on the first pass.
Conclusion:
MT via the transbrachial approach is a treatment option that should be considered, especially in MFS, where the transfemoral approach is difficult due to anatomical problems.
Insights
Mechanical thrombectomy (MT) is a viable treatment for acute ischemic stroke (AIS) in patients with Marfan syndrome (MFS). The transbrachial approach offers a solution when anatomical challenges hinder standard methods.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Genetics
Background:
- Marfan syndrome (MFS) is a genetic disorder affecting connective tissue, often leading to cardiovascular complications.
- These complications, including aortic aneurysms and dissections, can complicate standard endovascular procedures for acute ischemic stroke (AIS).
Observation:
- A 58-year-old woman with MFS presented with AIS, exhibiting complex aortic anatomy (Type III arch, thoracoabdominal tortuosity).
- Initial treatment with tissue plasminogen activator was followed by mechanical thrombectomy (MT) via a transbrachial approach due to difficult anatomy.
- A subsequent AIS event required a repeat MT, again successfully performed using the transbrachial route.
Findings:
- The transbrachial approach facilitated successful mechanical thrombectomy in a patient with Marfan syndrome and challenging aortic anatomy.
- Complete recanalization of the affected cerebral artery was achieved on the first pass during the second MT procedure.
Implications:
- The transbrachial approach is a crucial alternative for MT in AIS patients with Marfan syndrome, overcoming transfemoral access limitations.
- This case highlights the importance of considering alternative vascular access routes in complex neurovascular interventions.
