2024 Volume 46 Issue 2 Pages 127-133
A 73-year-old man was brought to our hospital for wake-up right hemiparesis, left conjugate deviation, and global aphasia. We diagnosed him with hyperacute cerebral infarction and performed mechanical thrombectomy. During mechanical thrombectomy, dysgenesis of his left ICA was detected. His left posterior communicating artery (PcomA) was occluded, and his left cerebral hemisphere was judged to be perfused using it as a major collateral pathway. We approached the occluded left PcomA via his left VA and recanalized the artery, resulting in improvement of symptoms. ICA dysgenesis is rare, occurring in less than 0.01% of patients, and is usually asymptomatic, but it becomes apparent when the main collateral vessels are occluded. It is important to confirm the existence or absence of the carotid canal by head CT and to identify the collateral pathway. Guiding devices through unusual pathways may be necessary, and careful device selection and handling are required, paying attention to potential aneurysms and atherosclerotic lesions.
