Kang JY, Yi KS, Cha SH, Choi CH, Kim Y, Lee J, Cho BS. Gelfoam embolization for distal, medium vessel injury during mechanical thrombectomy in acute stroke: A case report. World J Clin Cases 2021; 9(20): 5668-5674 [PMID: 34307623 DOI: 10.12998/wjcc.v9.i20.5668]
Corresponding Author of This Article
Kyung Sik Yi, MD, PhD, Clinical Associate Professor, Department of Radiology, Chungbuk National University Hospital, 776, 1Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea. yiksyi@gmail.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2021; 9(20): 5668-5674 Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5668
Gelfoam embolization for distal, medium vessel injury during mechanical thrombectomy in acute stroke: A case report
Ji Yun Kang, Kyung Sik Yi, Sang-Hoon Cha, Chi-Hoon Choi, Yook Kim, Jisun Lee, Bum Sang Cho
Ji Yun Kang, Kyung Sik Yi, Sang-Hoon Cha, Chi-Hoon Choi, Yook Kim, Jisun Lee, Bum Sang Cho, Department of Radiology, Chungbuk National University Hospital, Cheongju 28644, South Korea
Sang-Hoon Cha, Chi-Hoon Choi, Jisun Lee, Bum Sang Cho, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju 28644, South Korea
Author contributions: Yi KS, Choi CH and Cha SH performed IA thrombectomy, conseptualized the literature and contributed to manuscript drafting; Kim Y adviced using embolic material during the procedure; Kang JY and Yi KS reviewed the literature and contributed to manuscript drafting; Cha SH and Choi CH reviewed the literature and supervised editing; Lee J and Cho BS analyzed and interpreted the imaging findings; Kang JY and Yi KS were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported bythe Research Grant of the Chungbuk National University Hospital in 2020.
Informed consent statement: Written informed consent was obtained from the patient for publication of clinical data and accompanying images.
Conflict-of-interest statement: None of the authors has any potential conflicts to disclose (financial, professional, or personal) that are relevant to the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kyung Sik Yi, MD, PhD, Clinical Associate Professor, Department of Radiology, Chungbuk National University Hospital, 776, 1Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea. yiksyi@gmail.com
Received: March 5, 2021 Peer-review started: March 5, 2021 First decision: April 29, 2021 Revised: May 7, 2021 Accepted: May 15, 2021 Article in press: May 15, 2021 Published online: July 16, 2021
Abstract
BACKGROUND
Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions, and even distal, medium vessel occlusions. A distal, medium vessel has a tortuous course and thinner wall compared to large arteries, making it more susceptible to damage. Here, we review the treatment strategies for arterial perforation during mechanical thrombectomy, and we report the case of a patient treated with gelfoam embolization.
CASE SUMMARY
A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia. The initial National Institutes of Health Stroke Scale score was 15. Computed tomography (CT) and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion. During endovascular mechanical thrombectomy, arterial rupture occurred. The patient’s vital signs were stable, but delayed angiography showed persistent active bleeding. Therefore, selective embolization of the injured artery was performed using gelfoam. Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis. A localized subarachnoid hemorrhage (SAH) was confirmed on a follow-up CT scan. A repeated CT scan after 12 d showed resolution of the SAH, and rebleeding did not occur.
CONCLUSION
Rescue embolization with gelfoam could be considered an additional option in distal, medium vessel perforation.
Core Tip: Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions, and even for distal, medium vessel occlusions (DMVOs). Perforation tends to occur particularly with DMVOs, increases mortality, and lowers the rate of good functional outcomes. The optimal rescue technique for vessel perforation during mechanical thrombectomy has not been established. This case report reviews the treatment strategy of rescue embolization for arterial perforation and presents the case of a patient treated with gelfoam embolization.
