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The treatment option for acute ischaemic stroke depends on the duration of symptoms, the dynamics of neurological condition changes, the aetiology, type of stroke, as well as the results of angiographic and neuroimaging tests.
A 60-year-old male patient presented with progressive left hemisphere stroke caused by extensive cardiogenic embolism of th...
Context in source publication
Context 1
... electrocardiogram recorded atrial fibrillation with a ventricular rate of 70 beats/min. Ultra- sound examination and angio-CT scan (arterial and venous phase) of the head revealed a left-sided occlusion of the common carotid artery (CCA), external carotid artery, and the internal carotid artery (ICA) at the cavernous section (with an extended thrombus in the ICA above the embol- ism) (Figures 1 and 2). At this time, preserved blood flow was confirmed in the middle cerebral artery (MCA) and anterior cerebral artery (ACA) on the left side ( Figure 3). ...
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Objective: We report a case of embolic occlusion of the common carotid artery (CCA) in which a giant thrombus was retrieved using the parallel stent retriever technique.
Case presentation: An 84-year-old woman without anticoagulant therapy despite a history of cardioembolic stroke presented to our hospital because of left hemiparesis after developi...
Occurrence of acute middle cerebral artery occlusion with common carotid artery occlusion is rare, and its treatment may be complicated. If the approach route cannot be secured because of carotid artery occlusion, endovascular embolectomy may not be indicated. The best treatment approach for such cases remains controversial. A woman in her 70s was...
Background:
Emergency carotid artery stenting (CAS) is a frequent endovascular procedure, especially in combination with intracranial thrombectomy. Balloon guide catheters are frequently used in these procedures. Our aim was to determine if mechanical aspiration through the working lumen of a balloon occlusion catheter during the steps of a caroti...
Citations
... With its rigid and fibrous nature, it had to be eliminated piece by piece. There were few reports concerning the treatment of this level of large thrombus [1][2][3]. This treatment was less invasive and reasonable comparing a surgical embolectomy [1]. ...
... There were few reports concerning the treatment of this level of large thrombus [1][2][3]. This treatment was less invasive and reasonable comparing a surgical embolectomy [1]. Stein et al. treated three patients with CCA occlusion by systemic anticoagulation without an interventional approach [3]. ...
With recent innovative aspiration catheters, even a large thrombus in the internal carotid artery can be removed at a high rate. Though, we still sometimes have difficulty absorbing hard and large thrombus. Here, we report a case in which we eliminated a massive thrombus stuck in the common carotid artery in multi-steps. Tremendously large thrombus trapped in the common carotid artery is extremely rare. The thrombus was first loosened and deformed with balloon compression and removed with several attempts with an aspiration catheter and a stent retriever to finish it off. The thrombus was much larger than the thickest balloon-guide catheter and we had to pull it out and introduce it again for each time. It required a lot of work but was less-invasive and effective.
Objectives
In the endovascular treatment of acute cerebral large-vessel occlusion, cervical magnetic resonance angiography (MRA) is a useful modality for assessing the access route. However, we sometimes encounter cases in which not only the internal carotid artery (ICA), but also the common carotid artery (CCA) is poorly visualized, leading to hesitation over which devices and techniques to choose for revascularization. We retrospectively evaluated such cases, focusing on image findings and treatment results.
Materials and Methods
Data from 96 patients who underwent acute endovascular revascularization from January 2016 to December 2019 were analyzed. We extracted patients with poor CCA visualization on cervical MRA from 35 cases with ICA occlusion, and examined angiographic findings, treatment methods, and outcomes.
Results
Poor visualization of the CCA in cervical MRA was observed in 8 cases. All cases displayed atrial fibrillation or sick sinus syndrome. Angiographic findings showed true CCA occlusion in 2 patients and ICA occlusion in 6 patients. Reasons for the inability to visualize the CCA on cervical MRA were speculated to be stenosis of the external carotid artery (ECA), presence of embolism in the ECA, or severe heart failure. In cases of true CCA occlusion, thrombus was aspirated using the balloon guide catheter and good recanalization was obtained. Seven of 8 patients displayed favorable recanalization, with good prognosis after 90 days in 5 patients.
Conclusions
Poor CCA visualization on cervical MRA does not necessarily represent true CCA occlusion. Aspiration of thrombus from a balloon guide catheter is effective for true CCA occlusion.
