A case of emergent carotid artery stenting and thrombectomy with penumbra system for tandem internal carotid artery occlusion: case report

Abstract

Objective: We report a case of acute cerebral ischemia with tandem lesion in a patient who underwent emergent carotid artery stenting (CAS) and intracranial thrombectomy. Case presentation: A 59-year-old female suffering from aphasia and right hemiparesis was taken in ambulance, 78 minutes later from acute onset. National Institute of Health Stroke Scale was 25. Diffusion-weighted image (DWI) MRI showed acute infarction at left insula cortex, basal ganglia and frontal lobe, and MRA showed left internal carotid artery (ICA) occlusion. Clinical-DWI mismatch was admitted, we performed interventional therapy. DSA showed not only left intracranial ICA occlusion but also left cervical ICA severe stenosis. We placed carotid wallstent at cervical ICA stenosis site. After CAS, we performed thrombectomy for intracranial ICA, and gained complete recanalization. Postinterventional course was uneventful. Right hemiparesis was dramatically improved but motor aphasia was remained at discharge. Conclusion: We reported a case of acute cerebral infarction with tandem lesion leading to improving neurological deficits by CAS and thrombectomy. Interventional therapy for tandem lesion was useful.

New Cortical Spot Cerebral Infarction Out of Border Zone in ICA Occlusion Suggests Recanalization: A Case Report

“…The feasibility of emergent CAS in patients with acute ischemic stroke has been reported. 1 , 2 ) Nevertheless, the safety and feasibility of emergent CAS for an acutely occluded ICA have yet to be elucidated. Although there have been some reports of CAS for occluded ICA in the subacute or chronic phase, 3 ) it has potential hazardous risks such as dissection and extravasation for the neurointervention of occluded vessels, making it still quite challenging.…”

A Case of Internal Carotid Artery Restenosis Due to Neointimal Hyperplasia Following Balloon Angioplasty

“…Intracranial emboli must be collected, but there are two treatment options for lesions at the origin of the ICA: (1) balloon angioplasty is performed, followed by radical treatment after the condition becomes stable and (2) one-stage carotid artery stenting (CAS). 1) For one-stage CAS, it is necessary to use two antiplatelet drugs after surgery; this may lead to hemorrhagic infarction. Therefore, if possible, two-stage treatment is adopted.…”