Page 132 - AN-3-3

Advanced Neurology

CASE REPORT
Silent delayed middle cerebral artery occlusion

post-mechanical thrombectomy: A case report

Hideki Kanamaru* , Yoshinari Nakatsuka, Fumio Asakura, and Hiroto Murata
Department of Neurosurgery, Saiseikai Matsusaka General Hospital, Matsusaka, Mie, Japan

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.
*Corresponding author:
Hideki Kanamaru
(hideki-k-722@med.mie-u.ac.jp) Keywords: Ischemic stroke; Intracranial artery stenosis; Mechanical thrombectomy
Citation: Kanamaru H,
Nakatsuka Y, Asakura F, Murata H.
Silent delayed middle cerebral
artery occlusion post-mechanical 1. Background
thrombectomy: A case report.
Adv Neuro. 2024;3(3):3332. In the Global Burden of Disease Study 2019, ischemic stroke was identified as the
doi: 10.36922/an.3332 most common type of stroke, representing 62.4% of all stroke cases. In recent years,
1
Received: March 31, 2024 mechanical thrombectomy (MT) has been increasingly performed for acute ischemic
Accepted: June 11, 2024 stroke with large vessel occlusion. Advancements in devices used during the procedure
have significantly improved patient outcomes. However, progressive stenosis or
Published Online: August 19, 2024
reocclusion after treatment remains a concern, especially in cases with intracranial
Copyright: © 2024 Author(s). artery stenosis (ICAS). In Asia, ICAS accounts for up to 50% of all ischemic strokes.
2
3
This is an Open-Access article 4
distributed under the terms of the Both direct surgery (such as extracranial–intracranial arterial bypass [EC-IC bypass])
5
Creative Commons Attribution and endovascular treatment of stent placement for ICAS remain controversial. Herein,
License, permitting distribution, we present a case of acute large vessel occlusion treated with MT. This intervention
and reproduction in any medium,
provided the original work is caused an asymptomatic occlusion during the chronic phase, and an EC-IC bypass was
properly cited. subsequently performed to prevent further ischemic episodes.
Publisher’s Note: AccScience
Publishing remains neutral with 2. Case presentation
regard to jurisdictional claims in
published maps and institutional A 45-year-old male arrived at our hospital by emergency transport 1 h and 23 min
affiliations. after experiencing intermittent left-sided hemiparesis while driving. He had no

Volume 3 Issue 3 (2024) 1 doi: 10.36922/an.3332