Management of Mobile Thrombus With Distal Protection Devices During Carotid Artery Angioplasty: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Giuseppe Lanzino ◽  
Waleed Brinjikji ◽  
Adam Arthur ◽  
Mark Bain ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Video Production ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Cerebral Angiogram ◽  
Protection Devices

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.

scholarly journals Mechanical thrombectomy utilising a collateral pathway in a patient with dysgenesis of the internal carotid artery

2018 ◽  
Vol 25 (1) ◽  
pp. 54-57
Author(s):  
Jun Tsukano ◽  
Satoshi Kurabe ◽  
Tsutomu Sugai ◽  
Manabu Wada ◽  
Takashi Kumagai
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Left Middle Cerebral Artery ◽  
Collateral Pathway ◽  
Guiding Catheter ◽  
Left Middle

We describe a case of acute middle cerebral artery occlusion in a patient with ipsilateral internal carotid artery dysgenesis successfully treated with mechanical thrombectomy utilising a collateral pathway. During the procedure, a triaxial system using a balloon guiding catheter, flexible large lumen aspiration catheter and stent retriever was advanced from the left vertebral artery to the occluded left middle cerebral artery through the left posterior communicating artery. Because proximal aspiration from the balloon guiding catheter alone might have insufficient suction force due to the retrograde blood flow from large vascular communications (e.g. vertebral artery union), the tip of the flexible large lumen aspiration catheter was set at the proximal left middle cerebral artery, and distal aspiration was added during stent retrieval. A thrombolysis in cerebral infarction 2b result was achieved after the first pass. In this case, identification of carotid canal hypoplasia on computed tomography allowed for an immediate attempt of this alternative approach, avoiding a delay in the time to reperfusion.

scholarly journals Left internal carotid artery agenesis in a patient with headache

2014 ◽  
pp. 25-27
Author(s):  
Inês Alice Teixeira Leão ◽  
C. H. Rezende ◽  
J. B. L. Gomes ◽  
R. F. Almeida
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Clinical Neurology ◽  
Structural Lesion ◽  
Left Middle

Sometimes in clinical neurology, we diagnose a very rare case. We report on a patient who presented with crisis of headache and vomiting (clinically diagnose as migraine). Computed tomography (CT) scan of the head did not reveal any structural lesion. Magnetic resonance angiography showed absence of left internal carotid artery associated with absence of the left middle cerebral artery (MCA).

scholarly journals Hybrid approach in tandem high-grade carotid stenoses: A case report

2020 ◽  
Vol 28 (3) ◽  
pp. 539-542
Author(s):  
Valentin Govedarski
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Left Common Carotid Artery ◽  
Coronary Artery Bypass Grafts ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
High Grade ◽  
History Of

A 79-year-old male patient who presented with dizziness and several syncopal episodes was admitted to our clinic. Medical history of the patient revealed arterial hypertension and multifocal atherosclerosis with a history of two ischemic left middle cerebral artery strokes within the last year, without residual deficits, two coronary artery bypass grafts 22 years ago, and Stage IIB peripheral artery disease. The imaging studies revealed severe stenosis of the left internal carotid artery and high-grade ostial stenosis of the left common carotid artery. After clamping of the internal carotid artery and endarterectomy with patch angioplasty, before the patch was completely sutured, a sheath was placed through it and dilation and retrograde stenting of the proximal segment of the left common carotid artery were performed. The neurological symptoms of the patient disappeared and on postoperative computed tomography angiography, there was no residual carotid stenosis.

scholarly journals A Case of Pediatric Stroke: Osteosarcoma Embolus in the Internal Carotid Artery

2021 ◽  
pp. 269-275
Author(s):  
Christopher Troy ◽  
Jonathan Sisti ◽  
Angel Maldonado-Soto ◽  
Gabriella Tosto-D’antonio ◽  
Michael L. Miller ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Pediatric Population ◽  
Relevant Literature ◽  
Left Internal Carotid Artery ◽  
Pediatric Stroke ◽  
Retrospective Cohort Studies ◽  
Stroke Mimic

Stroke in the pediatric population is rare. Despite presentation similar to that seen in the adult patient, the diagnosis in a child can be missed or mistaken for a more common stroke mimic. Due to its rarity, there are no completed pediatric clinical trials investigating best treatment, though guidelines have been extrapolated from adult guidelines and retrospective cohort studies to include some combination of thrombolysis and mechanical thrombectomy. Rarer still is pediatric stroke caused by tumor embolus. We present the case of a young child diagnosed with stroke secondary to osteosarcoma embolism to the left internal carotid artery and review the relevant literature to discuss the considerations and challenges of treatment of stroke in the pediatric population.

Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 491-494 ◽  
Author(s):  
Vávrová ◽  
Slezácek ◽  
Vávra ◽  
Karlová ◽  
Procházka
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rare Complication ◽  
Left Internal Carotid Artery ◽  
Acute Tonsillitis ◽  
Artery Pseudoaneurysm ◽  
Complete Occlusion ◽  
Endovascular Approach ◽  
Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

scholarly journals Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance

2021 ◽  
Author(s):  
Walid Elshamy ◽  
Burcak Soylemez ◽  
Sima Sayyahmelli ◽  
Nese Keser ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Left Internal Carotid Artery ◽  
Total Resection ◽  
Complete Occlusion ◽  
Grade Ii

AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.

scholarly journals Successful Bridging Therapy in a 103-Year-Old Woman with Acute Terminal Internal Carotid Artery Occlusion

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 9-14
Author(s):  
Trung Quoc Nguyen ◽  
Hoang Thi Phan ◽  
Tinh Quang Dang ◽  
Vu Thanh Tran ◽  
Thang Huy Nguyen
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Left Internal Carotid Artery ◽  
Bridging Therapy ◽  
Nihss Score ◽  
Current Guidelines

The efficacy of intravenous thrombolysis and endovascular therapy and their favorable treatment outcomes have been established in clinical trials irrespective of age. Current guidelines do not recommend an age limit in selecting eligible patients for reperfusion treatment as long as other criteria are satisfied. A 103-year-old woman was admitted at our hospital within 1 h of stroke onset secondary to a left internal carotid artery terminus occlusion. On admission, her National Institutes of Health Stroke Scale (NIHSS) score was 30, with a small left thalamic diffusion restriction lesion on MRI. Her medical history included paroxysmal atrial fibrillation, prior myocardial infarction, hypertension, chronic kidney disease, and diabetes mellitus. Her pre-stroke modified Rankin Scale score was 0, and she was fully independent before stroke. Once intravenous thrombolysis was started, the patient successfully underwent mechanical thrombectomy, and thrombolysis in cerebral infarction-3 recanalization was achieved 225 min after symptom onset. She showed dramatic recovery (NIHSS score of 5 after 48 h) and was discharged on day 7 with a modified Rankin Score of 1. To our knowledge, our patient is the second oldest documented patient who successfully underwent bridging therapy for stroke.

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