2017 Volume 2 Issue 1 Pages 18-23
Objective: In 2015, the usefulness of mechanical thrombectomy for cerebral infarction was clarified. However, the usefulness of angioplasty for cerebral infarction with intra/extra-cranial major artery stenosis is still unclear. We report a patient with acute cerebral infarction who was successfully treated with thrombolytic therapy, mechanical thrombectomy, and angioplasty with stenting with a review of the literature.
Case presentation: A 62-year-old male was diagnosed with cerebral infarction associated with right internal carotid artery occlusion (ICA) in the previous hospital and transported to our hospital 158 minutes after onset. After intravenous thrombolysis with recombinant tissue plasminogen activator, endovascular treatment was performed, and imaging showed occlusion at ICA origin. When manual aspiration was performed using a 9Fr Optimo catheter inserted into the ICA, stenosis in the foramen lacerum could be confirmed. After percutaneous transluminal angioplasty (PTA) at the foramen lacerum of the ICA, mechanical thrombectomy was performed for M1 occlusion using Penumbra 5MAX ACE, and complete recanalization was achieved. For residual stenosis in the foramen lacerum of the ICA, a coronary stent was placed, and the procedure was completed. Head magnetic resonance angiogram (MRA) on the next day revealed improvement in the visualization of the anterior circulation, and the clinical findings also markedly improved.
Conclusion: We report a patient who showed a favorable course after manual aspiration in the internal carotid artery, intracranial PTA, mechanical thrombectomy in the right M1, and stenting for the residual stenosis in the intracranial internal carotid artery.