A Case of Acute Embolic Occlusion of the Brachiocephalic Artery Recanalized with Endovascular Thrombectomy

Abstract

Objective: Endovascular treatment of a patient with acute embolism of the brachiocephalic artery (BCA) is reported. Case Presentations:A 70-year-old woman presenting with weakness of the right upper extremity was transferred to our hospital due to acute embolism of the BCA. After the right brachial artery was secured by direct cardiovascular surgery, a balloon guidewire was inserted through the femoral artery and advanced near the thrombus in the BCA, and the balloon at its tip was inflated in the right internal carotid artery. Immediately after this, the thrombus in the BCA migrated to the right common carotid artery and right subclavian artery. The two vessels could be recanalized by endovascular treatment via a guide catheter and via the right brachial artery, respectively. Conclusion:In endovascular treatment for acute embolization of the BCA, the methods for thrombus retrieval and distal protection have not been established, and the concurrent direct surgery and cooperation by a cardiologist are indispensable.Keywords▶ cardiogenic embolism, embolic occlusion of brachiocephalic artery, endovascular thrombectomy, balloon-guide catheter, fogarty catheter

Long-sheath Introducer-assisted Revascularization (L-SHARE) Technique for Treating Large-vessel Occlusion by a Giant Clot

“…The time from the onset to reperfusion is one of the strongest predictors of the outcome in patients with LVO (10). Recently, the direct transfer to angiosuite (DTAS) protocol for patients suspected of having LVO based on a scoring system of acute stroke code, such as the Rapid Arterial oCclusion Evaluation (RACE) scale, was reported to be useful for shortening the time from admission to revascularization and improving the outcome (11,12) However, Pfaff et al reported that there was no significant difference in the door-to-reperfusion time between the DTAS group and the conventional workflow group (13,14). These results suggest that the reduction in in-hospital delays depends on the capability and availability of the angiosuite at the time of admission and the feasibility of a floor plan for treating AIS patients.…”

Acute Symptomatic Free-Floating Thrombus in the Innominate Artery, a Case Series

“…Exclusive endovascular treatment can sometimes be achieved by excluding the thrombus with the use of covered stents through a carotid cutdown with CCA control. Exclusive use of thrombectomy/aspiration catheters has also been described 17 ; however, it requires the use of multiple embolic protection devices (EPDs), making it cumbersome and at risk of embolism if the guidewire is pushed through the clot antegrade to place the EPD, so we consider this management a high-risk approach.…”

“…Exclusive endovascular treatment can sometimes be achieved by excluding the thrombus with the use of covered stents through a carotid cutdown with CCA control. Exclusive use of thrombectomy/aspiration catheters has also been described 17 ; however, it requires the use of multiple embolic protection devices (EPDs), making it cumbersome and at risk of embolism if the guidewire is pushed through the clot antegrade to place the EPD, so we consider this management a high-risk approach. Given that the IA is a large diameter (15-16 mm) and short artery, 18 it is not uncommon to lack a suitable stent-graft to cover arteries larger than 16 mm; in that case, treatment of the IA thrombus can be achieved by a hybrid procedure, excluding the thrombus with off-label use of widely available iliac extension stent-grafts and right subclavian artery revascularization when its origin is occluded by the stent-graft.…”

A Case of Acute Embolic Occlusion of the Common Carotid Artery in Which a Giant Thrombus Was Retrieved Using the Parallel Stent Retriever Technique

“…Surgery or hybrid treatment consisting of surgery and endovascular treatment has been reported. [2][3][4] In this study, we report a patient in whom thrombectomy for a giant thrombus in the CCA using the parallel stent retriever technique with two Solitaire (Medtronic, Minneapolis, MN, USA) devices led to complete recanalization.…”

“…Surgery or hybrid treatment consisting of surgery and endovascular treatment has been reported. 2 – 4) …”