Mechanical Thrombectomy of Acute Middle Cerebral Artery Occlusion using Trans-Anterior Communicating Artery Approach.

Mechanical Thrombectomy of Acute Middle Cerebral Artery Occlusion using Trans-Anterior Communicating Artery Approach.

World Neurosurg. 2018 Jan 12;:

Authors: Amuluru K, Romero CE, Pyle L, El-Ghanem M, Al-Mufti F

Abstract
BACKGROUND: A cross-circulation technique involves gaining access to a cerebral vessel through a patent anterior or posterior communicating artery. This technique may be utilized in patients with emergent large vessel occlusions and an unfavorable direct route to the occlusion. While few previous reports have demonstrated successful cross-circulation technique for treatment of emergent large vessel occlusions, we present the first two cases of trans-anterior communicating artery stent-retriever thrombectomy.
CASE DESCRIPTION: ▪ CASE #1: A 64-year-old female presented with acute right middle cerebral artery occlusion. She demonstrated a "triple-tandem" brachiocephalic-internal carotid artery (ICA)-middle cerebral artery (MCA) occlusion, thus precluding direct access to the right MCA. Successful stent-retriever mechanical thrombectomy was performed across the anterior communicating artery, using a left internal carotid artery approach. CASE #2: A 70-year old female presented with acute occlusion of the left middle cerebral artery and tandem occlusion of the cervical left internal carotid artery. Multiple attempts to catheterize the left common carotid artery were unsuccessful. She underwent successful stent-retriever mechanical thrombectomy across a patent anterior communicating artery, using a right internal carotid artery approach.
CONCLUSIONS: Timely recanalization of an occluded artery plays a critical role in the prognosis of patients with acute ischemic stroke. Successful stent-retriever mechanical thrombectomy of an occluded middle cerebral artery is possible using a trans-anterior communicating artery approach in patients without a direct access route to the occluded intracranial vessel. We review the pathophysiology of tandem lesions, access routes to intracranial occlusions, and the literature on cross-circulation techniques to treat emergent large vessel occlusions.

PMID: 29339323 [PubMed - as supplied by publisher]

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