scholarly journals Mechanical thrombectomy and carotid artery stenting for stenosis of the internal carotid artery with free-floating thrombosis: illustrative case

2021 ◽  
Vol 2 (9) ◽  
Author(s):  
Ryuta Tomoyose ◽  
Tomoyuki Tsumoto ◽  
Kenta Hara ◽  
Yuichi Miyazaki ◽  
So Tokunaga ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Acute Cerebral Infarction ◽  
Reversal Flow ◽  
Ica Stenosis

BACKGROUND The authors report a case in which mechanical thrombectomy and carotid artery stenting (CAS) were performed for acute cerebral infarction with free-floating thrombosis (FFT) in left internal carotid artery (ICA) stenosis. Good results were obtained. OBSERVATIONS A 63-year-old man developed sudden disturbance of consciousness and right hemiplegia. He was transported to the authors’ hospital by an emergency vehicle. Head magnetic resonance imaging showed acute cerebral infarction in the left middle cerebral artery region, and magnetic resonance angiography showed poor vascular flow beyond the left ICA. Emergency angiography revealed severe stenosis at the origin of the left ICA and a free-floating thrombus attached to the stenosis and extending to the peripheral side. Percutaneous transluminal angioplasty (PTA) was performed on the stenosis with proximal protection, the thrombus was aspirated under reversal flow, and CAS was performed without exacerbation of clinical symptoms. LESSONS PTA, thrombus aspiration, and CAS under reversal flow may be effective treatments for FFT caused by ICA stenosis.

scholarly journals Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

2019 ◽  
Vol 12 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Johannes A R Pfaff ◽  
Christoph Maurer ◽  
Erasmia Broussalis ◽  
Hendrik Janssen ◽  
Raphael Blanc ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Neurological Outcome ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Thrombus Formation ◽  
Extracranial Internal Carotid Artery ◽  
Stent Occlusion ◽  
Significant Difference

PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent.MethodsMulticenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries.ResultsOverall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9–18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent.ConclusionAcute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome.

scholarly journals Successful mechanical thrombectomy using a combined technique for internal carotid artery occlusion with persistent primitive trigeminal artery

2020 ◽  
Vol 11 ◽  
pp. 345
Author(s):  
Yoshinobu Horio ◽  
Kenji Fukuda ◽  
Takaya Yoshinaga ◽  
Ryuhei Takeyama ◽  
Hironori Fukumoto ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Scale Score ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Trigeminal Artery ◽  
Persistent Primitive Trigeminal Artery ◽  
Primitive Trigeminal Artery ◽  
Combined Technique

Background: The prevalence of persistent primitive trigeminal artery (PPTA) has been reported to be 0.1–0.6%. We report the successful recanalization of internal carotid artery (ICA) without embolization to new vascular territory (ENT) using a combined technique in a case of ICA occlusion with PPTA. Case Description: A 65-year-old female presented with sudden consciousness disorder. The Glasgow Coma Scale score was 7 (E1, V1, M5) and National Institutes of Health Stroke Scale score was 28. Magnetic resonance diffusion-weighted imaging showed areas of high signal intensity in the left frontal lobe, parietal lobe, insular cortex, and corona radiata. Magnetic resonance angiography showed occlusion of the left ICA distal to a PPTA. We performed mechanical thrombectomy (MT) using a combined technique with a balloon guide catheter (BGC), aspiration catheter, and stent retriever and achieved complete recanalization without ENT. The patient experienced a good postoperative recovery course. At 6 months, her Modified Rankin Scale score was 2. Conclusion: MT using a combined technique with BGC would be useful to prevent embolization to the posterior circulation through the PPTA in cases of ICA occlusion with PPTA.

Abstract TP242: Internal Carotid Artery Angle and the Risk of Floating Mural Thrombosis in Acute Cerebral Infarction Patients

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Yuko Abe ◽  
Yohei Mima ◽  
Yoshiki Esa ◽  
Aimi Tanaka ◽  
Naoko Ueda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Internal Carotid ◽  
Acute Cerebral Infarction

scholarly journals Emergent extracranial internal carotid artery stenting and mechanical thrombectomy in acute ischaemic stroke

2015 ◽  
Vol 21 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Ankit Mishra ◽  
Hannah Stockley ◽  
Tony Goddard ◽  
Hemant Sonwalker ◽  
Siddhartha Wuppalapati ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ischaemic Stroke ◽  
Cerebral Artery ◽  
Acute Ischaemic Stroke ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Extracranial Internal Carotid Artery ◽  
Mean Time

Objective Tandem occlusions involving both the extracranial internal carotid artery (ICA) and an intracranial artery typically respond poorly to intravenous (IV) tissue plasminogen activator (t-PA). We retrospectively review our experience with proximal ICA stenting and stent-assisted thrombectomy of the distal artery. Methods The data included patients that underwent carotid stenting and mechanical thrombectomy between 2012–2013. Radiographic, clinical, and procedural data were drawn from case notes, imaging records and discharge reports. Clinical outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRs). Results Seven patients, with a mean age of 66.4 years and a mean admission NIHSS of 18.3, underwent this procedure and were included. Each presented with an occlusion of the proximal ICA, with additional occlusions of the ICA terminus ( n = 3), middle cerebral artery ( n = 5), or anterior cerebral artery ( n = 1). Recanalisation of all identified occlusions was achieved in all patients, with a Thrombolysis in Myocardial Infarction (TIMI) score of 3 and a Thrombolysis in Cerebral Infarction (TICI) score >2b achieved in each case. Mean time from onset of stroke symptoms to recanalisation was 287 min; mean time from first angiography to recanalisation was 52 min. Intracranial haemorrhages occurred in two patients, with no increase in NIHSS. There were no mortalities. Mean NIHSS at discharge was 4.9, and mRs at 90 days was one in all patients. Conclusions Treatment of tandem extracranial ICA and intracranial occlusions in the setting of acute ischaemic stroke with extracranial carotid artery stenting followed by adjunctive intracranial mechanical thrombectomy is both safe and effective, but further evaluation of this treatment modality is necessary.

scholarly journals Efficacy of carotid thrombus penetration with a balloon guiding catheter to fast recanalization of acute extra- and intra-cranial carotid artery tandem occlusion - a preliminary report

2018 ◽  
Vol 32 (1) ◽  
pp. 65-72
Author(s):  
Ahmed Ansari ◽  
Tomotaka Ohshima ◽  
Shunsaku Goto ◽  
Taiki Yamamoto ◽  
Kojiro Ishikawa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenting ◽  
Preliminary Report ◽  
Internal Carotid ◽  
Anti Platelet Therapy ◽  
Tandem Occlusion ◽  
Ica Stenosis ◽  
Guiding Catheter

Abstract Acute ischemic stroke with ipsilateral Internal carotid artery (ICA) stenosis presents a great management dilemma. We present our preliminary report of retrograde retrieval of clot from middle cerebral artery (MCA) followed by delayed carotid artery stenting (CAS) with dual anti platelet therapy (DAPT).

Effect of emergent carotid stenting during endovascular therapy for acute anterior circulation stroke patients with tandem occlusion: A multicenter, randomized, clinical trial (TITAN) protocol

2020 ◽  
pp. 174749302092994 ◽  
Author(s):  
François Zhu ◽  
Gabriela Hossu ◽  
Marc Soudant ◽  
Sébastien Richard ◽  
Hamza Achit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Anterior Circulation ◽  
Tandem Occlusion

Background and hypothesis There is no consensus on the optimal endovascular management of the extracranial internal carotid artery steno-occlusive lesion in patients with acute ischemic stroke due to tandem occlusion. We hypothesized that intracranial mechanical thrombectomy plus emergent internal carotid artery stenting (and at least one antiplatelet therapy) is superior to intracranial mechanical thrombectomy alone in patients with acute tandem occlusion. Study design TITAN is an investigator-initiated, multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) study. Eligibility requires a diagnosis of acute ischemic stroke, pre-stroke modified Rankin Scale (mRS)≤2 (no upper age limit), National Institutes of Health Stroke Scale (NIHSS)≥6, Alberta Stroke Program Early Computed Tomography Score (ASPECTS)≥6, and tandem occlusion on the initial catheter angiogram. Tandem occlusion is defined as large vessel occlusion (intracranial internal carotid artery , M1 and/or M2 segment) and extracranial severe internal carotid artery stenosis ≥90% (NASCET) or complete occlusion. Patients are randomized in two balanced parallel groups (1:1) to receive either intracranial mechanical thrombectomy plus internal carotid artery stenting (and at least one antiplatelet therapy) or intracranial mechanical thrombectomy alone within 8 h of stroke onset. Up to 432 patients are randomized after tandem occlusion confirmation on angiogram. Study outcomes The primary outcome measure is complete reperfusion rate at the end of endovascular procedure, assessed as a modified Thrombolysis in Cerebral Infarction (mTICI) 3, and ≥4 point decrease in NIHSS at 24 h. Secondary outcomes include infarct growth, recurrent clinical ischemic event in the ipsilateral carotid territory, type and dose of antiplatelet therapy used, mRS at 90 (±15) days and 12 (±1) months. Safety outcomes are procedural complications, stent patency, intracerebral hemorrhage, and death. Economics analysis includes health-related quality of life, and costs utility comparison, especially with the need or not of endarterectomy. Discussion TITAN is the first randomized trial directly comparing two types of treatment in patients with acute ischemic stroke due to anterior circulation tandem occlusion, and especially assessing the safety and efficacy of emergent internal carotid artery stenting associated with at least one antiplatelet therapy in the acute phase of stroke reperfusion. Trial registration ClinicalTrials.gov NCT03978988

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