AccScience Publishing / AN / Volume 3 / Issue 3 / DOI: 10.36922/an.3332
CASE REPORT

Silent delayed middle cerebral artery occlusion post-mechanical thrombectomy: A case report

Hideki Kanamaru1* Yoshinari Nakatsuka1 Fumio Asakura1 Hiroto Murata1
Show Less
1 Department of Neurosurgery, Saiseikai Matsusaka General Hospital, Matsusaka, Mie, Japan
Advanced Neurology 2024, 3(3), 3332 https://doi.org/10.36922/an.3332
Submitted: 31 March 2024 | Accepted: 11 June 2024 | Published: 19 August 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Mechanical thrombectomy (MT) for atherothrombotic lesions entails significant risks, including reocclusion and the possibility of worsening stenotic changes through endothelial injury. We treated a 45-year-old male admitted to our hospital with the sudden onset of left hemiparesis. Magnetic resonance imaging (MRI) revealed an occlusion of the right middle cerebral artery (MCA). Immediate intravenous tissue plasminogen activator infusion followed by MT successfully reperfused the MCA, although residual stenosis persisted in the distal portion of the M1 segment. Following the procedure, the patient’s symptoms resolved, and he was discharged. Three months later, follow-up MRI showed reocclusion of the right MCA and hemodynamic changes indicating reduced cerebral blood flow and cerebrovascular reactivity in the MCA territory. Subsequently, extracranial–intracranial bypass surgery was performed, and the patient did not develop any new symptoms postoperatively. While the patient in this case did not develop permanent symptoms, diligent observation is imperative following MT due to the potential for delayed progressive stenosis or occlusion.

Keywords
Ischemic stroke
Intracranial artery stenosis
Mechanical thrombectomy
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795-820. doi: 10.1016/s1474-4422(21)00252-0

 

  1. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352(13):1305-1316. doi: 10.1056/NEJMoa043033

 

  1. Wong LK. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1(3):158-159. doi: 10.1111/j.1747-4949.2006.00045.x

 

  1. EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med. 1985;313(19):1191-1200. doi: 10.1056/nejm198511073131904

 

  1. Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365(11):993-1003. doi: 10.1056/NEJMoa1105335

 

  1. Turk AS, Spiotta A, Frei D, et al. Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2014;6(3):231-237. doi: 10.1136/neurintsurg-2013-010713

 

  1. Powers WJ, Clarke WR, Grubb RL Jr., Videen TO, Adams HP Jr., Derdeyn CP. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: The Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306(18):1983-1992. doi: 10.1001/jama.2011.1610

 

  1. Yamauchi H, Fukuyama H, Nagahama Y, et al. Evidence of misery perfusion and risk for recurrent stroke in major cerebral arterial occlusive diseases from PET. J Neurol Neurosurg Psychiatry. 1996;61(1):18-25. doi: 10.1136/jnnp.61.1.18

 

  1. Grubb RL Jr., Derdeyn CP, Fritsch SM, et al. Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA. 1998;280(12):1055-1060. doi: 10.1001/jama.280.12.1055

 

  1. Yamauchi H, Higashi T, Kagawa S, et al. Is misery perfusion still a predictor of stroke in symptomatic major cerebral artery disease? Brain. 2012;135(Pt 8):2515-2526. doi: 10.1093/brain/aws131

 

  1. Kataoka H, Miyamoto S, Ogasawara K, et al. Results of prospective cohort study on symptomatic cerebrovascular occlusive disease showing mild hemodynamic compromise [Japanese extracranial-intracranial bypass trial (JET)-2 study]. Neurol Med Chir (Tokyo). 2015;55(6):460-468. doi: 10.2176/nmc.oa.2014-0424

 

  1. Zaidat OO, Fitzsimmons BF, Woodward BK, et al. Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: The VISSIT randomized clinical trial. JAMA. 2015;313(12):1240-1248. doi: 10.1001/jama.2015.1693

 

  1. Gao P, Wang T, Wang D, et al. Effect of stenting plus medical therapy vs medical therapy alone on risk of stroke and death in patients with symptomatic intracranial stenosis: The CASSISS randomized clinical trial. JAMA. 2022;328(6):534-542. doi: 10.1001/jama.2022.12000

 

  1. Yeo JYP, Yau CE, Ong NY, et al. Comparing the Impact of stenting vs. medical therapy for intracranial arterial stenosis: A systematic review and one-stage and two-stage meta-analysis of randomized clinical trials. Clin Neuroradiol. 2024;34:379-390. doi: 10.1007/s00062-023-01370-3

 

  1. Enomoto Y, Takagi T, Matsubara H, et al. Delayed stenosis in the intracranial vessels following endovascular treatment for acute stroke. J Vasc Interv Radiol. 2015;26(12):1814-1819. doi: 10.1016/j.jvir.2015.08.014

 

  1. Labeyrie MA, Civelli V, Reiner P, et al. Prevalence and treatment of spontaneous intracranial artery dissections in patients with acute stroke due to intracranial large vessel occlusion. J Neurointerv Surg. 2018;10(8):761-764. doi: 10.1136/neurintsurg-2018-013763

 

  1. Teng D, Pannell JS, Rennert RC, et al. Endothelial trauma from mechanical thrombectomy in acute stroke: In vitro live-cell platform with animal validation. Stroke. 2015;46(4):1099-1106. doi: 10.1161/strokeaha.114.007494

 

  1. Eugène F, Gauvrit JY, Ferré JC, et al. One-year MR angiographic and clinical follow-up after intracranial mechanical thrombectomy using a stent retriever device. AJNR Am J Neuroradiol. 2015;36(1):126-132. doi: 10.3174/ajnr.A4071
Share
Back to top
Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing