A case of left middle cerebral artery embolism due to Takayasu’s arteritis in the common carotid artery

Abstract

Objective: We report a rare case of left middle cerebral artery embolism due to Takayasu's arteritis in the common carotid artery. Case presentation: A 24-year-old female presented with motor aphasia and right hemiparesis. MRI showed early ischemic changes in the left insular cortex. Cervical MRA showed occlusion of left common carotid artery and left middle cerebral artery (MCA). Because the patient was ineligible for intravenous recombinant tissue plasminogen activator, we chose endovascular therapy for recanalization. Aorta angiogram demonstrated typical findings of Takayasu's arteritis and occlusion extending from the distal M1 to M2 segment of the MCA. Therefore, we performed thrombolysis passing catheter through the Pcom and thrombectomy using a Penumbra ® system. The occluded MCA was successfully recanalized and good clinical outcome was obtained. Conclusion: We considered that the left MCA occlusion was caused by artery-to-artery embolism derived from Takayasu's arteritis. This is the first report of thrombectomy using a Penumbra ® system of the thrombus due to Takayasu's arteritis.

A Case of Acute Ischemic Stroke Treated with Endovascular Treatment for Tandem Occlusion of the Common Carotid Artery and Internal Carotid Artery Terminal Portion Related to Takayasu Arteritis

“…Urokinase at 480000 units was intra-arterially injected and aspiration with a Penumbra 3MAX led to recanalization. 5) The other patient had occlusion of the bilateral ICA. Aspiration with a Penumbra for right ICA occlusion led to TICI 2b recanalization, and the use of a stent retriever for left ICA occlusion resulted in TICI 2b recanalization.…”

“…3) In Japan, Watanabe et al 4) reported that the incidence was 13.2%, and that embolism was observed in 3.7% of these patients. The pathogenesis of cerebral infarction in the presence of this disease is assumed as follows 5) :…”

“… 3) In Japan, Watanabe et al 4) reported that the incidence was 13.2%, and that embolism was observed in 3.7% of these patients. The pathogenesis of cerebral infarction in the presence of this disease is assumed as follows 5) : (1) vascular stenosis-related blood flow failure, (2) thrombus-derived embolism related to vascular-wall irregularity or turbulence, and (3) vascular occlusion related to dissection of the media. In the present case, blood flow stasis/a thrombus of the CCA as the blind end may have caused embolism, inducing ischemic stroke.…”

“…Regarding acute-phase mechanical thrombectomy for major cerebral artery occlusion related to Takayasu arteritis, two case reports have been published. 5 , 6) One patient had chronic occlusion of the left CCA and acute occlusion of the left MCA. For approaching, the left CCA was unable to be adopted and a posterior approach via the left PcomA was used.…”