Case ReportTrans-Anterior Communicating Artery Primary Stenting in Acute Tandem Middle Cerebral Artery–Internal Carotid Artery Occlusion Due to Thoracic Aortic Stent Graft
Introduction
The main target of stroke intervention is the revascularization of an occluded vessel, usually achieved with thrombectomy1 or thrombus aspiration.2 Despite good results in limited series,3, 4, 5, 6 intracranial primary stenting is controversial for increased hemorrhagic risk owing to the need for dual antiplatelet therapy.7 Other problems concern the risk of early thrombosis and long-term durability. We present a case of trans-anterior communicating artery (AComA) primary stenting in acute tandem middle cerebral artery (MCA)–internal carotid artery (ICA) occlusion in a patient harboring a thoracic aortic stent graft partially covering the origin of the left common carotid artery (CCA).
Section snippets
Case Presentation
A 53-year-old man was admitted to our hospital with right-sided hemiplegia and aphasia on awakening. Two years earlier, he had undergone thoracic aorta aneurysm stent grafting with left CCA debranching and reimplantation. He was receiving anticoagulant therapy with warfarin. At admission (4 hours after awakening), his National Institutes of Health Stroke Scale was 18, and he underwent a stroke diagnostic protocol with plain brain computed tomography (CT), CT angiography (CTA), and CT perfusion
Discussion
Recanalization has been identified as the most important modifiable prognostic factor for favorable outcomes in ischemic stroke treatment.8 Bailout intracranial stenting is emerging as a feasible solution in patients with acute large-vessel occlusion after stentriever thrombectomy failure.9 On the other hand, studies of primary intracranial stenting remain limited. Our review of the recent literature found only 1 series4, 5 and 1 trial3, 6 of primary intracranial stenting in acute ischemic
Conclusion
Our experience with this patient suggests that primary intracranial stenting may be considered in selected cases, when other revascularization techniques are difficult or impossible to perform owing to anatomic reasons. Extreme care should be taken in patient selection owing to the risks related to antiplatelet therapy and transcirculation navigation.
References (15)
- et al.
Stentriever thrombectomy failure: a challenge in stroke management
World Neurosurg
(2017) - et al.
Intra-arterial fibrinolysis via the contralateral internal carotid artery for acute ischemic stroke
J Stroke Cerebrovasc Dis
(2005) - et al.
Tandem middle cerebral artery-internal carotid artery occlusions: primary stenting of M1 and M2 tract crossing the anterior communicating artery
JACC Cardiovasc Interv
(2015) - et al.
Safety and efficacy of solitaire stent thrombectomy: individual patient data meta-analysis of randomized trials
Stroke
(2016) - et al.
A Direct Aspiration, First Pass Technique (ADAPT) versus stent retrievers for acute stroke therapy: an observational comparative study
AJNR Am J Neuroradiol
(2016) - et al.
First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (Stent-Assisted Recanalization in Acute Ischemic Stroke)
Stroke
(2009) - et al.
Primary stenting for acute ischemic stroke using the Enterprise vascular reconstruction device: early results
J Neurointerv Surg
(2014)
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.