Complete recanalization by using a thrombectomy device in a patient with internal carotid artery occlusion

Abstract

We report on a patient who presented with acute internal carotid artery (ICA) occlusion and was recanalized completely using a novel embolectomy device (Merci Retriever) after failed intravenous tPA therapy.
A 58-year-old man who suffered left paralysis and dysarthria was transported to our institution 40 minutes after onset, and his NIHSS was 10 on admission. Diffusion MR imaging showed a small high-intensity lesion in the right middle cerebral artery territory, and MRA showed total occlusion of the right ICA. His neurological symptoms did not improve after intravenous tPA. Emergency angiography showed a severe stenosis of the right ICA bifurcation and an occlusion of the tip of the right ICA, and it was diagnosed as an artery-to-artery embolism.
A thrombectomy using a Merci Retriever was then attempted after successful carotid stenting. After the first procedure, the occluded ICA was opened to the distal M1 portion of middle cerebral artery. The complete recanalization of the ICA was obtained after the second procedure. His neurological symptoms improved markedly, and his modified Rankin Scale score was 1 on discharge. An endovascular embolectomy using a Merci Retriever can significantly restore the blood flow of an occluded ICA during acute ischemic stroke, which is otherwise expected to have a poor outcome.