Acute internal carotid artery occlusion due to dissection of the paraclinoid segment: Diagnostic usefulness of angiographic findings during stent retriever deployment

Radiology Case Reports

article

Isao Sasaki¹  Taichiro Imahori¹  Tatsuya Yano¹  Kana Onobuchi¹  Masanori Gomi¹  Junko Kuroda¹  Norikata Kobayashi¹  Kimitoshi Sato¹  Yoji Niwa¹  Koichi Iwasaki¹  Hiroshi Hasegawa¹ 

[1] Department of Neurosurgery, Ainomiyako Neurosurgery Hospital

关键词: Acute ischemic stroke;    Dissection;    Large vessel occlusion;    Endovascular treatment;    Mechanical thrombectomy;    Stent retriever;   

DOI  :  10.1016/j.radcr.2022.10.017

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

Intracranial artery dissection is an uncommon but possible cause of ischemic stroke, and is usually diagnosed based on imaging findings such as mural hematoma and dissection flap. However, it is challenging to recognize the underlying dissection in cases of acute large vessel occlusion. In this report, we present a case of acute internal carotid artery occlusion, in which the underlying dissection of the paraclinoid segment was found during the thrombectomy procedure. Two thrombectomy procedures failed to recanalize the acute internal carotid artery occlusion without removing any clot. Angiography performed during a Trevo stent retriever deployment in the first pass showed obscure contrast defects in the stent strut with temporary flow restoration. In the next pass, the appearance of the contrast defects changed and a parallel linear contrast appeared on the outside of the vessel wall. These angiographic findings were identified as mural hematoma and dissection flap, indicating dissection of the paraclinoid as the cause of the occlusion. During antiplatelet loading and preparation of a dedicated intracranial stent, the Trevo stent retriever was left deployed again at the occlusion site to maintain the blood flow. After permanent stenting with an Enterprise stent, angiography revealed complete recanalization. The patient recovered fully after the procedure. In the present case, stent retriever deployment revealed the hallmarks of dissection on angiography, such as mural hematoma, dissection flap, and temporal morphological changes, by restoring the blood flow temporarily. Such angiographic findings can provide useful information on the occlusion characteristics and real-time feedback for optimal treatment strategy.

【 授权许可】

CC BY|CC BY-NC-ND