Mechanical Thrombectomy within 6 h after Symptom Onset in Ischemic Stroke

Abstract

Background: A 40-year-old male presented with progressive left lower limb pain on a background of left knee surgery some 20 years prior. Examination revealed a thrill and bruit in the left popliteal fossa and diagnostic angiography confirmed a large arteriovenous fistula (AVF). Methods: Over-the-wire Fog arty catheter was used to exclude flow through the AVF and image run-off vessels. The native popliteal artery measured 6.5 mm above and below the fistula and an 8 mm × 50 mm Gore Viabahn covered stent was used to exclude the AVF with good results. The patient was started on clopidogrel and therapeutic anticoagulation with warfarin postoperatively. Results: This case illustrates the endovascular repair of a large, chronic AVF in which open surgery would have been very challenging. The majority of data on long-term primary patency of popliteal covered stents results from aneurysm treatment and is estimated to be 69.4% at 5 years. Conclusion: Treatment of chronic AV fistulas using covered stents in the popliteal region is a viable alternative to open repair.