A case of mechanical thrombectomy for occluded middle cerebral artery fenestration

Abstract

Fenestration of the middle cerebral artery (MCA) is rare but can be a pitfall for mechanical thrombectomy. We experienced a case of complete recanalization using ADAPT in a case of occluded MCA fenestration. A 71-year-old man with left hemiparesis and dysarthria was transported to our hospital. National Institutes of Health Stroke Scale (NIHSS) was 7 on admission. Diffusion-weighted imaging showed some high-intensity spots in the right MCA region, and magnetic resonance angiography (MRA) showed the right M1 near occlusion. On angiography, we found a linear contrasting loss part in M1 and we diagnosed occlusion of the M1 fenestration. We performed mechanical thrombectomy using ADAPT. We achieved complete recanalization (modified thrombolysis in cerebral infarction grade 3); the left hemiparesis improved postoperatively. Postoperative MRA showed fenestration in the right M1. He was treated with antiplatelet therapy and discharged with modified Rankin Scale (mRS) 1 on postoperative day 12. From this study we conclude that when we find a linear contrasting loss part in M1, we should suspect M1 fenestration. The superior limb should be recanalized as priority.