Intraoperative Support Using a Virtual Fluoroscopic Image in Thrombosis Recovery Treatment

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Objective: It is often difficult and has a potential risk of vessel injury to navigate a catheter or a microcatheter through the difficult types of aortic arches and through an occluded segment of the intracranial arteries under fluoroscopic guidance alone. Herein, we demonstrate a supportive technique of virtual fluoroscopic imaging from a data of non-contrast CT for a case of thrombectomy for acute occlusion of the right middle cerebral artery (MCA).

Case Presentation: An 85-year-old woman was transferred to our hospital with complaints of left-sided paralysis, dysarthria, and aphasia. CT revealed a hyperdense MCA sign, suggesting acute right MCA occlusion. CT showed bovine type of aortic arch too. Subsequently, mechanical thrombectomy was performed with the right brachial approach. A guiding catheter and a microcatheter system were successfully navigated into the target lesion under virtual fluoroscopic imaging guidance, and then thrombolysis in cerebral infarction (TICI) 3 recanalization was obtained in puncture-to-recanalization time of 37 minutes.

Conclusion: Virtual fluoroscopic images helped us to perform thrombectomy in a case of acute MCA occlusion, which provided anatomical information on the artery distal to the occlusion site, and were useful in determining the direction of the wire guidance.