Successful transcirculation thrombectomy through the posterior communicating artery for acute MCA occlusion: a case...

In a transcirculation thrombectomy, the communicating arteries are used to access the anterior circulation via the posterior circulation, or vice versa. This approach can be used in patients where traditional anterograde endovascular approaches are challenging due to complex vascular anatomy or chronic lesions involving extracranial and intracranial vessels. Up until now only a few articles addressed this approach. Here, we present a case of a 68-year-old woman who presented with a sudden-onset left-sided weakness. CT angiography showed an occlusion of the common carotid artery (CCA) on the right side and an ipsilateral occlusion in the M1 segment of the middle cerebral artery (MCA). A transcirculation approach was used to perform a successful embolectomy for the right MCA occlusion through the patent posterior communicating artery (Pcomm). At discharge, the patient had mild deficits and fully recovered at 1-month follow-up. Our case highlights the effectiveness and safety of this technique, despite potential complications like prolonged procedure time. Further research is needed to optimize patient selection and technique.