Endovascular management of iatrogenic dissection into the petrous segment of the internal carotid artery during mechanical thrombectomy for acute stroke

Abstract Embolic protection devices (EPDs) have become a standard of care during internal carotid artery revascularization.1,2 This video is about a 57-yr-old-male who presented with a wake-up stroke with a left hemispheric syndrome. Head computed tomography angiography (CTA) revealed tandem occlusions of the proximal left internal carotid artery (ICA) and of the distal left middle cerebral artery (MCA) with an ASPECT (Alberta Stroke Program Early CT Score) score of 6. The patient underwent a cerebral angiogram and was treated with balloon angioplasty with a distal EPD and mechanical thrombectomy. The EPD became occluded with thrombus from the ICA and was retrieved through a 6-Fr Sofia (MicroVention) under continuous aspiration. Successful revascularization of the proximal ICA and distal MCA was achieved. No procedure-related complications occurred, and the patient's neurological exam improved. Tandem occlusions can occur in up to 15% of strokes. The optimal treatment can be controversial, but mechanical thrombectomy and ICA revascularization with a distal EPD appear to be safe and effective in selected patients.3 Consent was obtained for the procedure and for the video production.

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Use of Neuroform Stent in a Patient with Acute Stroke Caused by Spontaneous Petrous Segment Internal Carotid Artery Dissection

Interventional Neuroradiology ◽

10.1177/159101990401000209 ◽

2004 ◽

Vol 10 (2) ◽

pp. 155-160 ◽

Cited By ~ 1

Author(s):

D. Mitra ◽

A. Herwadkar ◽

A. Gholkar

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Acute Stroke ◽

Intracranial Aneurysms ◽

Internal Carotid ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Neuroform Stent ◽

Intracranial Circulation

Neuroform stents have been recently introduced for treatment of broad-necked intracranial aneurysms. Several studies have demonstrated the feasibility of deployment of Neuroform stents (Boston Scientific Target, USA) in intracranial circulation. We report a case of a patient presenting with acute stroke due to occlusive petrous segment internal carotid artery dissection who was treated with a Neuroform stent.

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Bilateral mechanical thrombectomy for internal carotid artery occlusion and contralateral middle cerebral artery occlusion during transvenous thrombolysis: Case report

Nosotchu ◽

10.3995/jstroke.10941 ◽

2021 ◽

Author(s):

Satoshi Inoue ◽

Atsushi Fujita ◽

Koji Shinoda ◽

Takashi Mizowaki ◽

Te Jin Lee ◽

...

Keyword(s):

Case Report ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Cerebral Artery Occlusion

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Abstract WP20: Efficacy and Safety of Mechanical Thrombectomy in Emergent Large Vessel Occlusions with Concomitant Cervical Internal Carotid Artery Occlusion

Stroke ◽

10.1161/str.48.suppl_1.wp20 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Abhi Pandhi ◽

Yasser M Khorchid ◽

Abhishek Ojha ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Efficacy And Safety ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Cervical Internal Carotid Artery

Introduction: Recently, five published major randomized controlled clinical trials have demonstrated that timely mechanical thrombectomy (MT) of acute ischemic strokes (AIS) with emergent large vessel occlusion (ELVO) is safe and improves functional outcomes. However, data evaluating the efficacy and safety of MT in ELVO patients with concomitant cervical internal carotid artery (cICA) occlusion is limited. The purpose of this study is to evaluate efficacy and safety of MT in ELVO patients with concomitant cICA occlusion Methods: We prospectively analyzed consecutive AIS patients with anterior circulation ELVO who underwent stent-retriever or primary aspiration thrombectomy at two tertiary stroke centers. Outcome measures in our study were 3-month mortality and modified ranking scale (mRS), as well as symptomatic intracranial hemorrhage (sICH). Safety and efficacy outcomes were compared between ELVO patients with and without concomitant cICA occlusion. Results: A total of 137 AIS patients had anterior circulation ELVO and underwent MT (age 63 ± 14, 49% male, median NIHSS 17, IQR [13-20]). ELVO patients with concomitant cICA occlusion (n=19) did not differ in terms of rates of sICH (0% versus 11%, p=0.21), complete recanalization (68 % versus 68%, p=1.00), onset to groin puncture time (minutes [IQR] 268 [211-379] versus 225 [165-312], p=0.47), 3-month mortality (35% versus 26 %, p=0.55), and mRS of 0-2 at 3 months (41% versus 45%, p=0.80) when compared with ELVO patients without concomitant cICA occlusion (n=118). Admission NIHSS was higher among ELVO patients with concomitant cICA occlusion (median [IQR], 18 [15-22] versus 16 [12-19], p=0.01), and they tended to have higher groin puncture to recanalization time (minutes [IQR] 74 [42-97] versus 49 [38-78], p=0.09). The ordinal shift analysis did not show any difference in favorable outcomes in two groups in unadjusted analyses or after adjustment for admission NIHSS and groin to recanalization time (common OR=0.78 [95% CI: 0.27-2.29, p=0.66]). Angioplasty was performed in 11 of 19 ELVO patients with concomitant cICA occlusion. Three patients required stent placement. Discussion: Our study indicates that MT can be performed safely and effectively in ELVO patients with concomitant cICA occlusion.

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