Percutaneous Mechanical Thrombectomy in a Patient with Symptomatic Carotid Stenosis and Ipsilateral Middle Cerebral Artery Occlusion

Abstract

Objective: We report a case of acute internal carotid artery (ICA) severe stenosis completely recanalized using a stent placement and a Solitaire FR.
Case presentation: A 72-year-old man presented with sudden onset of left hemiplegia and dysarthria. MRI showed early ischemic changes in the right insular cortex and frontal cortex along with right severe ICA stenosis. Cerebral angiography demonstrated severe stenosis at the origin of the right ICA and middle cerebral artery (MCA) occlusion. The ICA stenosis was improved by stent placement at the origin of ICA, and MCA occlusion was done by thrombectomy using the Solitaire FR resulting in neurological improvement.
Conclusion: IV-tPA therapy was not particularly useful in patients with ICA severe stenosis. However, if standard medical management is ineffective in patients with acute cerebral infarction due to tandem arterial lesions, combined percutaneous revascularization of each lesions can prevent catastrophic events.