Treatment of Middle Cerebral Artery Occlusion with Concomitant Partially Thrombosed Aneurysm: a Case Report
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Treatment of Middle Cerebral Artery Occlusion with Concomitant Partially Thrombosed Aneurysm: a Case Report Michel Klapp Oliger 1 & Till-Karsten Hauser 1 & Franz-Josef Strauss 2,3 & Ulrike Ernemann 1 Accepted: 5 November 2020 / Published online: 17 November 2020 # The Author(s) 2020
Abstract A 68-year-old female with an acute ischemic stroke demanding emergency thrombectomy which was complicated by the presence of an intracranial aneurysm. Computer tomography revealed the occlusion of the right middle cerebral artery with a distal non-ruptured partially thrombosed aneurysm. The treatment consisted in the administration of intravenous recombinant tissue plasminogen activator and the removal of the proximal thrombus via direct aspiration in order to prevent perforation of the distal aneurysm. After the procedure, the clinical symptoms improved significantly indicated by the National Institutes of Health Stroke Scale (NIHSS). The aim of the present case report is, therefore, to suggest a clinical approach to help physicians in the decision-making process for early and safe revascularization in patients with ischemic stroke and intracranial aneurysms. Keywords Aneurysm . MCA . Endovascular . Thrombosed . Thrombectomy . Direct aspiration
Introduction The prompt restoration of the cerebral blood flow via reperfusion therapy is the most effective procedure to prevent tissue infarction due to ischemia. However, the efficacy of this procedure depends on the time of reperfusion as the benefits of reperfusion decrease over time. The first-line therapy in patients with acute ischemic stroke is intravenous alteplase (recombinant tissue plasminogen activator or tPA) which should be provided within the first 4.5 h following the onset of symptoms [1–3]. On the other hand, in patients with acute ischemic stroke but with a large artery occlusion in the anterior circulation, mechanical thrombectomy is indicated regardless of whether the patient had received intravenous alteplase for the same ischemic stroke event [4, 5].
* Michel Klapp Oliger [email protected] 1
Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
2
Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
3
Department of Conservative Dentistry, School of Dentistry, University of Chile, Santiago, Chile
The acute occlusion of the middle cerebral artery in conjunction with a distal aneurysm of the same blood vessel is a rare event, but can be more common than we think, especially in older hypertensive women [6]. As a consequence, the available evidence is limited in terms of treatment approaches [6–8]. Here we present a successful interventional approach with mechanical thrombectomy of the middle cerebral artery in a patient with a concomitant distal aneurysm of the same vessel.
Case Report A 68-year-old female was referred to our hospital approximately 2.5 h after acute onset of hemiparesis of the left side and aphasia. Clinical
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