Troubleshooting Intraprocedural Arterial Perforation during Acute Revascularization Therapy by Transarterial Embolization with NBCA

Abstract

Background: Intracranial hemorrhage after endovascular revascularization for acute ischemic stroke is associated with a poor outcome. Case Presentation: An 86-year-old man developed sudden left hemiparesis. He had a baseline National Institutes of Health Stroke Scale (NIHSS) score of at least 16 and showed no improvement with intravenous administration of tissue plasminogen activator (tPA). Cerebral angiography was performed with conscious sedation, which confirmed an occlusion of the superior division of the right middle cerebral artery (MCA). Microcatheter was used to penetrate the MCA during manipulation of the occluded vessel. We performed transarterial embolization with n-butyl 2-cyanoacrylate (NBCA) to treat intraprocedural arterial perforation during acute revascularization therapy. Hemostasis along with patency of parent artery was achieved. Postoperative computed tomography (CT) confirmed no hemorrhagic lesion. Conclusion: We concluded that embolization using NBCA might be acceptable to be one of the effective hemostatic agents for this purpose.