Abstract 1122‐000207: Mechanical Thrombectomy of the Fetal Posterior Cerebral Artery

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mohamad Abdalkader ◽  
Mohamad Abdalkader ◽  
Anurag Sahoo ◽  
Adam A Dmytriw ◽  
Waleed Brinjikji ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Clinical Presentation ◽  
Posterior Cerebral Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ct Angiogram ◽  
Procedural Complications ◽  
High Index Of Suspicion

Introduction : Fetal posterior cerebral artery (FPCA) occlusion is a rare but potentially disabling cause of stroke. While endovascular treatment is established for acute large vessel occlusion (LVO) stroke, FPCA occlusions were excluded from acute ischemic stroke trials. We aim to report the feasibility, safety and outcome of mechanical thrombectomy (MT) in acute FPCA occlusions. Methods : We performed a multi‐center retrospective review of consecutive patients who underwent MT of acute FPCA occlusion. Primary FPCA occlusion was defined as an occlusion that was identified on the pre‐procedure CT angiogram or baseline angiogram whereas a secondary FPCA occlusion was defined as an occlusion that occurred secondary to embolization to a new territory after recanalization of a different LVO. Demographics, clinical presentation, imaging findings, endovascular treatment and outcome were reviewed. Results : There were twenty‐five patients with acute FPCA occlusion who underwent MT, distributed across 14 centers. Median NIHSS on presentation was 16. There were 76% (19/25) of patients who presented with primary FPCA occlusion and 24% (6/25) of patients who had a secondary FPCA occlusion. The configuration of the FPCA was full in 64% patients and partial or “fetal‐type” in 36% of patients. FPCA occlusion was missed on initial CTA in 21% of patients with primary FPCA occlusion (4/19). The site of occlusion was posterior communicating artery in 52%, P2 segment in 40% and P3 in 8% of patients. TICI 2b/3 reperfusion was achieved in 96% of FPCA patients. There were no intra‐procedural complications. At 90 days, 48% (12/25) were functionally independent as defined by mRS≤2. Conclusions : Endovascular treatment of acute FPCA occlusion is safe and technically feasible. A high index of suspicion is important to detect occlusion of the fetal posterior cerebral artery in patients presenting with anterior circulation stroke syndrome and patent anterior circulation.

scholarly journals Mechanical Thrombectomy of the Fetal Posterior Cerebral Artery

2021 ◽  
Author(s):  
Mohamad Abdalkader ◽  
Anurag Sahoo ◽  
Adam A. Dmytriw ◽  
Waleed Brinjikji ◽  
Guilherme Dabus ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion

Abstract BACKGROUND Fetal posterior cerebral artery (FPCA) occlusion is a rare but potentially disabling cause of stroke. While endovascular treatment is established for acute large vessel occlusion stroke, FPCA occlusions were excluded from acute ischemic stroke trials. We aim to report the feasibility, safety, and outcome of mechanical thrombectomy in acute FPCA occlusions. METHODS We performed a multicenter retrospective review of consecutive patients who underwent mechanical thrombectomy of acute FPCA occlusion. Primary FPCA occlusion was defined as an occlusion that was identified on the pre‐procedure computed tomography angiography or baseline angiogram whereas a secondary FPCA occlusion was defined as an occlusion that occurred secondary to embolization to a new territory after recanalization of a different large vessel occlusion. Demographics, clinical presentation, imaging findings, endovascular treatment, and outcome were reviewed. RESULTS There were 25 patients with acute FPCA occlusion who underwent mechanical thrombectomy, distributed across 14 centers. Median National Institutes of Health Stroke Scale on presentation was 16. There were 76% (19/25) of patients who presented with primary FPCA occlusion and 24% (6/25) of patients who had a secondary FPCA occlusion. The configuration of the FPCA was full in 64% patients and partial or “fetal‐type” in 36% of patients. FPCA occlusion was missed on initial computed tomography angiography in 21% of patients with primary FPCA occlusion (4/19). The site of occlusion was posterior communicating artery in 52%, P2 segment in 40% and P3 in 8% of patients. Thrombolysis in cerebral infarction 2b/3 reperfusion was achieved in 96% of FPCA patients. There were no intraprocedural complications. At 90 days, 48% (12/25) were functionally independent as defined by modified Rankin scale≤2. CONCLUSIONS Endovascular treatment of acute FPCA occlusion is safe and technically feasible. A high index of suspicion is important to detect occlusion of the FPCA in patients presenting with anterior circulation stroke syndrome and patent anterior circulation. Novelty and significance This is the first multicenter study showing that thrombectomy of FPCA occlusion is feasible and safe.

Acute occlusion of the fetal posterior cerebral artery: diagnosis and management paradigms

2021 ◽  
pp. 197140092110193
Author(s):  
Mohamad Abdalkader ◽  
Anurag Sahoo ◽  
Julie G Shulman ◽  
Elie Sader ◽  
Courtney Takahashi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery ◽  
Management Strategies ◽  
Artery Occlusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Cerebral Artery Occlusion

Background and purpose The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. Methods We performed a retrospective review of consecutive patients presenting with acute large vessel occlusion who underwent cerebral angiogram and/or mechanical thrombectomy between January 2015 and January 2021. Patients diagnosed with fetal posterior cerebral artery occlusion were included. Demographic data, clinical presentation, imaging findings and management strategies were reviewed. Results Between January 2015 and January 2021, three patients with fetal posterior cerebral artery occlusion were identified from 400 patients who underwent angiogram and/or mechanical thrombectomy for acute stroke (0.75%). The first patient presented with concomitant fetal posterior cerebral artery and middle cerebral artery occlusions. Thrombectomy was performed with recanalisation of the fetal posterior cerebral artery but the patient died from malignant oedema. The second patient presented with isolated fetal posterior cerebral artery occlusion. No endovascular intervention was performed and the patient was disabled from malignant posterior cerebral artery infarct. The third patient presented with carotid occlusion and was found to have fetal posterior cerebral artery occlusion after internal carotid artery recanalisation. No further intervention was performed. The patient was left with residual contralateral homonymous hemianopia and mild left sided weakness. Conclusion Fetal posterior cerebral artery occlusion is a rare, but potentially disabling, cause of ischaemic stroke. Endovascular treatment is feasible. Further investigation is needed to compare the efficacy of medical versus endovascular management strategies.

scholarly journals 3MAX catheter for thromboaspiration of downstream and new territory emboli after mechanical thrombectomy of large vessel occlusions: initial experience

2018 ◽  
Vol 25 (3) ◽  
pp. 277-284 ◽  
Author(s):  
Fabio Settecase
Keyword(s):  
Cerebral Artery ◽  
Prospective Studies ◽  
Cerebral Ischaemia ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery ◽  
Large Vessel ◽  
Initial Experience ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Procedural Complications

Distal emboli and emboli to new territories occur in up to 14% and 11% of large vessel occlusion mechanical thrombectomies, respectively. A retrospective review was conducted of 18 consecutive patients with large vessel occlusion acute stroke undergoing mechanical thrombecomy, subsequently developing distal emboli and/or emboli to new territory for which thromboaspiration using the 3MAX catheter was performed. Eighteen distal emboli and two emboli to new territory in 18 patients were treated in the distal M2 and M3 middle cerebral artery, pericallosal and callosomarginal arteries, and P2 posterior cerebral artery (all arteries ≥1.5 mm in diameter). 3MAX thromboaspiration was successful in 13/18 distal emboli and 2/2 emboli to new territory (total 15/20, 75%). 3MAX thromboaspiration resulted in improvement in the final modified treatment in cerebral ischaemia (mTICI) score in 14/18 patients (78%) compared with the initial mTICI score after large vessel occlusion thrombectomy. A shift towards higher final mTICI scores was seen with 3MAX catheter aspiration of distal emboli in this series. The initial mTICI score after large vessel occlusion thrombectomy was 2A in 4/18 (22%) patients and 2B in 14/18 (78%) patients. The final mTICI score after distal emboli/emboli to new territory aspiration improved to 2B in 7/18 (39%) patients, 2C in 3/18 (17%) patients and 3 in 8/18 (44%) patients. No procedural complications were noted. In 13 patients with successful distal emboli/emboli to new territory thromboaspiration, a 90-day modified Rankin score of 0–2 was seen in 10 patients (77%). In five patients with unsuccessful distal emboli/emboli to new territory aspiration, a 90-day modified Rankin score of 0–2 was seen in three patients (60%). 3MAX thromboaspiration of select distal emboli and emboli to new territories is feasible. Larger prospective studies are needed to establish the clinical benefit and safety of this approach.

Abstract P539: Comparison of Transradial Artery versus Transfemoral Artery Access for Solumbra Technique in Mechanical Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Taha Nisar ◽  
Jimmy Patel ◽  
Muhammad Z Memon ◽  
Amit Singla ◽  
Priyank Khandelwal
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arrival Time ◽  
Mechanical Thrombectomy ◽  
Retrospective Chart Review ◽  
Functional Independence ◽  
Binary Logistic Regression Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Number Of Patients

Introduction: Solumbra technique involves the simultaneous use of stent-retriever and large-bore aspiration for clot retrieval in mechanical thrombectomy (MT). We aim to compare various time parameters in patients who undergo MT via solumbra technique via transradial artery (TRA) approach vs. transfemoral artery (TRF) approach. Methods: We performed a retrospective chart review of patients who underwent MT via solumbra technique for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 5/2020. We compared time to recanalization parameters, score of TICI≥2b, and functional independence (3-month mRS≤2) in patients who underwent MT via TRA vs.TRF approach via the solumbra technique. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment-NIHSS, type of anesthesia (general vs.moderate), laterality, and clot location [proximal (internal carotid or M1 segment of the middle cerebral artery) vs.distal (M2 or M3 segment of the middle cerebral artery)]. Results: A total of 98 patients met our inclusion criteria. The mean age was 63.59±14.40 years. 18 (18.37%) patients underwent MT through transradial approach. In our cohort, there was a significant association of TRA with shorter angio suite arrival-time to puncture-time (22.12±9.92mins vs.28.83±12.26mins; OR, 0.94; 95% CI, 0.88-1; P 0.026), but not with puncture-time to recanalization-time (84.34±61.34mins vs.63.73±35.29mins; OR, 1.01; 95% CI, 1-1.03; P 0.085), angio suite arrival-time to recanalization-time (103.12±51.29mins vs.93.42±39.08mins; OR, 1.01; 95% CI, 1-1.02; P 0.524), number of passes to recanalization (1.78±1.36 vs.1.68±1.05; OR, 1.03; 95% CI, 0.66-1.63 ; P 0.899), number of patients with TICI≥2b (83.34% vs.91.25%; OR, 0.68; 95% CI, 0.14-3.4; P 0.633), and functional independence (66.67% vs.78.75%; OR, 0.49; 95% CI, 0.13-1.86; P 0.292), when compared to TRF approach for MT using solumbra technique. Conclusion: Our study demonstrates a significant association between TRA approach with shorter angio suite arrival-time to puncture-time but not with overall time to recanalization, number of patients with TICI≥2b, and functional independence, when compared to TRF approach for MT using solumbra technique.

Abstract TP15: A Case for the Chase? A Case Series of Mechanical Thrombectomy of M2 Occlusions

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hisham Salahuddin ◽  
Julie Shawver ◽  
Gretchen Tietjen ◽  
Syed Zaidi ◽  
Mouhammad Jumaa
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Randomized Clinical Trials ◽  
Mechanical Thrombectomy ◽  
Tertiary Care ◽  
Case Series ◽  
Anterior Circulation ◽  
Institutional Review ◽  
Tertiary Care Centers

Introduction: Randomized clinical trials have demonstrated an improvement in outcomes with endovascular treatment of large vessel occlusions, however studies evaluating the effectiveness of endovascular treatment of smaller vessels of the anterior circulation are lacking. We present initial data from two tertiary care centers with a focus on outcomes of patients with isolated middle cerebral artery (MCA) M2 occlusions. Methods: With institutional review board approval, we retrospectively reviewed medical records of patients who underwent mechanical thrombectomy (MT) between September 2013 and June 2016. The following data was collected: demographics, stroke risk factors, intravenous tPA use, MT treatment times, grade of recanalization, complications, and 3 month modified Rankin Scores. A favorable clinical outcome was defined as a modified Rankin Scale (mRS) 0-2 at 90 days. Results: A total of 50 patients were included in this analysis with 19 (38%) women and 31 (62%) men, with a mean age of 70 (63-80) years. One patient had an occlusion of both superior and inferior divisions of the middle cerebral artery (MCA) artery, 20 had occlusion of the inferior M2 artery, and the remaining 29 had occlusion of the superior division of the MCA. Baseline characteristics are summarized below. Average door to groin time was 75 (46-112) minutes, mean procedure time was 30 (25-47) minutes, and mean onset of symptoms to recanalization time was 220 (156-305) minutes. Of the cohort, 22 patients had a change of mRS of 3 or more at the time of discharge, 25 (50%) patients had a favorable outcome at 3 months, and 4 (8%) patients were lost to follow up. Ten (20%) patients developed hemorrhagic infarction and five (10%) developed parenchymal hematoma. Conclusions: Our data on MT targeting M2 occlusions demonstrates reasonable safety, recanalization rates, complications, and functional outcomes. Randomized studies are needed to confirm the benefit of pursuing MCA M2 occlusions with MT.

scholarly journals A review of endovascular treatment for medium vessel occlusion stroke

2021 ◽  
pp. neurintsurg-2021-017321
Author(s):  
Johanna Maria Ospel ◽  
Mayank Goyal
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Standard Of Care ◽  
Current Standard ◽  
Vessel Occlusion ◽  
Clear Guideline ◽  
Being There

Medium-vessel occlusions (MeVOs), that is, occlusions of the M2/3 middle cerebral artery, A2/3 anterior cerebral artery, and P2/3 posterior cerebral artery segments, account for 25%–40% of all acute ischemic stroke cases. Clinical outcomes of MeVO stroke with intravenous thrombolysis, which is the current standard of care, are moderate at best. With improving imaging technologies and a growing literature, MeVOs are increasingly recognized as a target for endovascular treatment (EVT). For the time being, there is limited but promising evidence for the safety and efficacy of MeVO EVT, and many neurointerventionists are already routinely offering EVT for MeVO stroke, despite the lack of clear guideline recommendations. In this article, we review the evidence on endovascular treatment for MeVO stroke and summarize the available literature on current imaging strategies, commonly used EVT selection criteria, EVT techniques, and outcome assessment for MeVO stroke.

NCCT and CTA-based imaging protocol for endovascular treatment selection in late presenting or wake-up strokes

2018 ◽  
Vol 11 (2) ◽  
pp. 200-203 ◽  
Author(s):  
Telma Santos ◽  
Andreia Carvalho ◽  
André Almeida Cunha ◽  
Marta Rodrigues ◽  
Tiago Gregório ◽  
...  
Keyword(s):  
Observational Study ◽  
Endovascular Treatment ◽  
Time Window ◽  
Functional Independence ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Imaging Protocol ◽  
Procedural Complications ◽  
Symptomatic Intracranial Hemorrhage

IntroductionRecently, the benefit of selecting patients for endovascular treatment (EVT) beyond the 6-hour time window using a tissue-based approach was demonstrated in two randomized trials. The optimal imaging protocol for selecting patients is under debate, and it is still unknown if a simpler and faster protocol may adequately select patients with wake-up stroke (WUS) and late-presenting stroke (LPS) for EVT.ObjectiveTo compare outcomes of patients submitted to EVT presenting within 6 hours of symptom onset or 6–24 hours after last seen well, selected using non-contrast computed tomography (NCCT) and CT angiography (CTA).MethodsAn observational study was performed, which included consecutive patients with anterior circulation ischemic stroke with large vessel occlusion treated with EVT. Patients presenting within 6 hours were treated if their NIH Stroke Scale (NIHSS) score was ≥6 and Alberta Stroke Program Early CT score (ASPECTS) was ≥6, while patients presenting with WUS or 6–24 hours after last seen well (WUS/LPS) were treated if their NIHSSscore was ≥12 and ASPECTS was ≥7.Results249 patients were included, 63 of whom were in the WUS/LPS group. Baseline characteristics were similar between groups, except for longer symptom-recanalization time, lower admission NIHSS (16 vs 17, P=0.038), more frequent tandem occlusions (25.4% vs 11.8%, P=0.010), and large artery atherosclerosis etiology (22.2% vs 11.8%, P=0.043) in the WUS/LPS group. No differences in symptomatic intracranial hemorrhage, peri-procedural complications or mortality were found between groups. Three-month functional independence was similar in both groups (65.1% in WUS/LPS vs 57.0% in ≤6 hours, P=0.259) and no differences were found after adjustment for confounders.ConclusionsThis real-world observational study suggests that EVT may be safe and effective in patients with WUS and LPS selected using clinical-core mismatch (high NIHSS/high ASPECTS in NCCT).

The Anterior Temporal Approach for Microsurgical Thromboembolectomy of an Acute Proximal Posterior Cerebral Artery Occlusion

2013 ◽  
Vol 10 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Felix Goehre ◽  
Hiroyasu Kamiyama ◽  
Akira Kosaka ◽  
Toshiyuki Tsuboi ◽  
Shiro Miyata ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Treatment Option ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Modified Rankin Scale ◽  
Effective Treatment Option ◽  
Anterior Circulation ◽  
Brain Vessels ◽  
Cerebral Artery Occlusion

Abstract BACKGROUND: In a short window of time, intravenous and intra-arterial thrombolysis is the first treatment option for patients with an acute ischemic stroke caused by the occlusion of one of the major brain vessels. Endovascular treatment techniques provide additional treatment options. In selected cases, high revascularization rates following microsurgical thromboembolectomy in the anterior circulation were reported. A technical note on successful thromboembolectomy of the proximal posterior cerebral artery has not yet been published. OBJECTIVE: To describe the technique of microsurgical thromboembolectomy of an acute proximal posterior cerebral artery occlusion and the brainstem perforators via the anterior temporal approach. METHODS: The authors present a technical report of a successful thromboembolectomy in the proximal posterior cerebral artery. The 64-year-old male patient had an acute partial P1 thromboembolic occlusion, with contraindications for intravenous recombinant tissue plasminogen activator. The patient underwent an urgent microsurgical thromboembolectomy after a frontotemporal craniotomy. RESULTS: The postoperative computerized tomography angiography showed complete recanalization of the P1 segment and its perforators, which were previously occluded. The early outcome after 1 month and 1 year follow-ups showed improvement from modified Rankin scale 4 to modified Rankin scale 1. CONCLUSION: Microsurgical thromboembolectomy can be an effective treatment option for proximal occlusion of the posterior cerebral artery in selected cases and experienced hands. Compared with endovascular treatment, direct visual control of brainstem perforators is possible.

scholarly journals A Comparison of Mechanical Thrombectomy in the M1 and M2 Segments of the Middle Cerebral Artery: A Review of 585 Consecutive Patients

2017 ◽  
Vol 6 (3-4) ◽  
pp. 191-198 ◽  
Author(s):  
Pervinder Bhogal ◽  
Philipp Bücke ◽  
Muhammad AlMatter ◽  
Oliver Ganslandt ◽  
Hansjörg Bäzner ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Haemorrhage ◽  
Mechanical Thrombectomy ◽  
Outcome Data ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Computed Tomographic ◽  
Significant Difference

Background: Mechanical thrombectomy for anterior-circulation large-vessel occlusion has shown benefit; however, the question of whether this technique is safe and effective in the distal vasculature remains unanswered. We sought to compare the outcome data from mechanical thrombectomy of the M2 branches of the middle cerebral artery (MCA) with those of the M1 segment. Methods: We performed a retrospective analysis of prospectively collected data of patients with acute ischaemic stroke undergoing mechanical thrombectomy of isolated M1 or M2 branches of the MCA between August 2008 and August 2016. Results: We identified 585 patients, 479 with M1 occlusions and 106 with M2 occlusions. The average age was 72 ± 12.8 and 68 ± 13.8 years, respectively (p = 0.007). The baseline Alberta Stroke Program Early Computed Tomographic (ASPECT) score was similar in both cohorts, but patients with M1 occlusions presented with higher mean National Institutes of Health Stroke Scale (NIHSS) scores of 15.7 compared to 11.8 (p < 0.001). There was no significant difference in the average procedure time for each cohort; fewer thrombectomy attempts were required in the M2 cohort (2.3 vs. 1.8, p = 0.0004), but the overall time to recanalization was longer in the M2 cohort (353 vs. 399 min, p < 0.001). Similar rates of successful reperfusion (Thrombolysis in Ischaemic Stroke score [TICI] ≥2b 88.5 vs. 90.5%, p = 0.612) were seen, but food outcome (modified Rankin Scale ≤2) was lower in M1 occlusions (37.2 vs. 54.3%, p < 0.001). Rates of symptomatic intracranial haemorrhage were similar. Conclusion: Good clinical outcomes can be achieved for both groups with no significant differences in procedure length, final TICI recanalization rates or intracranial haemorrhage between the M1 and M2 cohorts.

scholarly journals Arterial Dissection Following the Use of Remote Aspiration Thrombectomy

2018 ◽  
Vol 09 (03) ◽  
pp. 417-419 ◽  
Author(s):  
Craig Kilburg ◽  
M. Yashar S. Kalani ◽  
Min S. Park
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Arterial Dissection ◽  
Left Middle Cerebral Artery ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Guide Catheter ◽  
Ct Angiogram

ABSTRACTRemote aspiration thrombectomy using a balloon guide catheter for acute carotid artery occlusion has been proposed as a safe and effective technique. We present a case of iatrogenic arterial dissection of the distal cervical segment in a patient with proximal vessel occlusion who underwent attempted revascularization using this strategy. A 57-year-old male patient presented with computed tomography (CT) angiogram evidence of a left carotid terminus and M1 segment occlusion. The patient was taken emergently for mechanical thrombectomy. Remote aspiration thrombectomy was attempted twice using manual aspiration through a balloon guide catheter in the common carotid artery; however, this resulted in minimal recanalization of the carotid terminus and a new iatrogenic dissection within the internal carotid artery (ICA) just proximal to the skull base. Despite multiple additional attempts at mechanical thrombectomy, only limited recanalization of the ICA terminus and anterior cerebral artery distribution was achieved, with no significant flow past the M1 segment. After the procedure, a large ischemic territory within the left middle cerebral artery distribution consistent with the continued M1 segment occlusion was apparent on CT. The patient died on the poststroke day 6. Although remote aspiration thrombectomy for thromboemboli in this location has potential benefits, it should be used cautiously given the potential risk of injury to the proximal vasculature.

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