Published online Feb 6, 2020. doi: 10.12998/wjcc.v8.i3.630
Peer-review started: October 13, 2019
First decision: November 13, 2019
Revised: November 19, 2019
Accepted: December 6, 2019
Article in press: December 6, 2019
Published online: February 6, 2020
The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset. For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex. Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.
The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion. Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.
Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.
Core tip: We report a case of acute carotid artery and ipsilateral middle cerebral artery occlusion. The anatomy of the aortic arch was complex. We chose carotid artery incision thrombectomy combined with stent thrombectomy for this patient because of the following reasons. First, the anatomy of the aortic arch was complex, and simple intravascular treatment would take a longer time to establish the interventional path. Second, the embolus was located in the bifurcation of the carotid artery and the ipsilateral middle cerebral artery. There was no obvious embolus in the remaining segments of the internal carotid artery, so there was positive blood flow in the internal carotid artery. In such patients, carotid stent implantation for carotid artery embolization might result in distal escape of the thrombus.