Mechanical Thrombectomy of Distal Occlusions in the Anterior Cerebral Artery: Recanalization Rates, Periprocedural Complications, and Clinical Outcome

Abstract

BACKGROUND AND PURPOSE:Patients with acute ischemic stroke in the anterior circulation are at risk for either primary or, following mechanical thrombectomy, secondary occlusion of the anterior cerebral artery. Because previous studies had only a limited informative value, we report our data concerning the frequency and location of distal anterior cerebral artery occlusions, recanalization rates, periprocedural complications, and clinical outcome.

Anterior cerebral artery embolism during thrombectomy increases disability and mortality

“…The main limit of the classification was the significant differences in reported rates depending on whether CT or MR was used. ACA infarcts are described as less frequent than ACAE, and efficient rescue maneuvers of ACAE are considered to improve the global successful reperfusion at the end of the procedure 15. However, our results do not support the latter point and suggest that ACAE occurrence is far from inconsequential in the long term.…”

Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success

“…Even though none of the randomized controlled trials included clots distal to M2, there are stent retrievers available today with smaller diameter, typically 3 mm, which may be used in smaller arteries. Although distal thrombectomy in the anterior cerebral artery has been reported to have high revascularization rate with low complication profile [44], our anecdotal experience suggests that very distal thrombectomy in both the middle and posterior cerebral arteries carries an increased risk for focal subarachnoid hemorrhage and potentially focal ischemia due to perforator injury. Because these distal arteries are less robust and more loosely attached to the parenchyma, a thrombectomy maneuver may displace an entire arterial segment whereby the perforators are at risk for being detached.…”

Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Lower NIHSS Scores: Recanalization Rates, Periprocedural Complications, and Clinical Outcome

“…[23][24][25] Asymptomatic subarachnoid hemorrhage and angiographically occult vessel perforations can be detected quite frequently in follow-up imaging after mechanical thrombectomy in Table 2: List of types, manufacturers, and number of maneuvers for mechanical thrombectomy up to 16.1% of patients. 21,26 Angiographically apparent vessel perforations and symptomatic subarachnoid hemorrhage occur in 0.6%-2.9% of patients after mechanical thrombectomy, 1,4,5,27,28 and reports addressing the immediate treatment of vessel perforation after mechanical thrombectomy have been published. 29 In our case, despite stent deployment without any problems and after a previous retrieval maneuver that had already recanalized the middle cerebral artery main branch, symptomatic subarachnoid hemorrhage occurred following a second retrieval maneuver, causing an MCA perforation (distal M2 segment).…”