Junpei Koge1, Seiya Kato2, Tetsuya Hashimoto3, Yukihiko Nakamura4, Masakazu Kawajiri3, Takeshi Yamada3. 1. Division of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan. Electronic address: j.kouge@gmail.com. 2. Division of Pathology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan. 3. Division of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan. 4. Division of Neurosurgery, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan.
Abstract
BACKGROUND: Experimental evidence that stent retriever thrombectomy (SRT) may cause arterial wall damage is increasing, although histopathologic findings focused on vessel wall injury after SRT have not fully been reported in humans. CASE DESCRIPTION: We describe an autopsy case of an 82-year-old woman who presented with acute left intracranial internal carotid artery occlusion and received SRT. When we attempted to catheterize the M1 segment of the normal middle cerebral artery (MCA), we were not aware of a duplicated MCA and advanced the microcatheter into the main MCA trunk with a smaller caliber than that of the normal M1 segment. A 6-mm Trevo thrombectomy device was deployed from the main MCA trunk but was insufficiently expanded in the MCA segment. Two passes with a Trevo resulted in failed recanalization. The patient died on postoperative day 4 because of extensive infarction. Autopsy revealed a duplicated MCA and subintimal arterial dissection in the proximal segment of the main MCA trunk. The supraclinoid internal carotid artery also revealed endothelial denudation and mural thrombus. CONCLUSIONS: We provide a histopathologic report of vessel wall injury after SRT that caused failed recanalization. Anatomic variations of the MCA should be considered when selecting suitable thrombectomy devices in order to avoid vessel wall injury.
BACKGROUND: Experimental evidence that stent retriever thrombectomy (SRT) may cause arterial wall damage is increasing, although histopathologic findings focused on vessel wall injury after SRT have not fully been reported in humans. CASE DESCRIPTION: We describe an autopsy case of an 82-year-old woman who presented with acute left intracranial internal carotid artery occlusion and received SRT. When we attempted to catheterize the M1 segment of the normal middle cerebral artery (MCA), we were not aware of a duplicated MCA and advanced the microcatheter into the main MCA trunk with a smaller caliber than that of the normal M1 segment. A 6-mm Trevo thrombectomy device was deployed from the main MCA trunk but was insufficiently expanded in the MCA segment. Two passes with a Trevo resulted in failed recanalization. The patient died on postoperative day 4 because of extensive infarction. Autopsy revealed a duplicated MCA and subintimal arterial dissection in the proximal segment of the main MCA trunk. The supraclinoid internal carotid artery also revealed endothelial denudation and mural thrombus. CONCLUSIONS: We provide a histopathologic report of vessel wall injury after SRT that caused failed recanalization. Anatomic variations of the MCA should be considered when selecting suitable thrombectomy devices in order to avoid vessel wall injury.
Authors: David Hernández; José Luis Cuevas; Laura Ludovica Gramegna; Manuel Requena; Carlos Piñana; Marta de Dios; Pilar Coscojuela; Marielle Esteves; Jiahui Li; Alberto Gil; Marc Ribó; Alejandro Tomasello Journal: Transl Stroke Res Date: 2022-06-08 Impact factor: 6.829
Authors: Oana Madalina Mereuta; Mehdi Abbasi; Seán Fitzgerald; Daying Dai; Ram Kadirvel; Ricardo A Hanel; Albert J Yoo; Mohammed A Almekhlafi; Kennith F Layton; Josser E Delgado Almandoz; Peter Kvamme; Vitor Mendes Pereira; Babak S Jahromi; Raul G Nogueira; Matthew J Gounis; Biraj Patel; Amin Aghaebrahim; Eric Sauvageau; Parita Bhuva; Jazba Soomro; Andrew M Demchuk; Ike C Thacker; Yasha Kayan; Alexander Copelan; Pouya Nazari; Donald Robert Cantrell; Diogo C Haussen; Alhamza R Al-Bayati; Mahmoud Mohammaden; Leonardo Pisani; Gabriel Martins Rodrigues; Ajit S Puri; John Entwistle; Alexander Meves; Jorge L Arturo Larco; Luis Savastano; Harry J Cloft; David F Kallmes; Karen M Doyle; Waleed Brinjikji Journal: J Neurointerv Surg Date: 2021-05-11 Impact factor: 5.836