Endovascular treatment of tandemic occlusions in acute ischemic stroke

The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented. Man, 61 years...

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Autores principales: D.V. Shcheglov, V.N. Zahorodnii, S.V. Konotopchik, A.A. Pastushin
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Publicado: NAMS of Ukraine, State Organization "Scientific-Practical Center of Endovascular Neuroradiology, Non-Governmental Organization “All Ukrainian Association of Endovascular Neuroradiology, Shupyk National Healthcare University of Ukraine 2021
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spelling oai:doaj.org-article:dab127de9fbb4b198010cd331fc6e3a12021-11-21T16:40:50ZEndovascular treatment of tandemic occlusions in acute ischemic stroke2786-48552786-486310.26683/2786-4855-2021-2(36)-73-81https://doaj.org/article/dab127de9fbb4b198010cd331fc6e3a12021-11-01T00:00:00Zhttps://enj.org.ua/index.php/journal/article/view/183https://doaj.org/toc/2786-4855https://doaj.org/toc/2786-4863The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented. Man, 61 years old. He was delivered to the Center of endovascular neuroradiology, NAMS of Ukraine on January 15, 2021 with an ischemic stroke clinic in the left internal carotid artery basin. He fell ill acutely ‒ against the background of complete well-being, sensorimotor aphasia and right-sided hemiplegia appeared. Upon admission on the NIHSS (National Institutes of Health Stroke Scale) ‒ 18 points. On the performed initial multispiral computed tomography of the brain according to ASPECTS (Alberta Stroke Program Early CT score) ‒ 8 points. In the endovascular operating room, cerebral angiography was performed, followed by surgery aimed at restoring cerebral blood flow. The time from the onset of the disease to the puncture was 330 minutes, the duration of the operation was 135 minutes, thus the time from the onset of the disease to reperfusion was 465 minutes. Angiography revealed acute thrombosis of the left ICA starting from the orifice, M1-segment of the left MCA and A2-segment of the left ACA. Partial compensation of the basin through the supra-block anastomosis (external carotid artery ‒ ICA), as well as from the vertebro-basilar system through the network of leptomeningeal arteries. Collaterals ‒ ACG 3. Thrombosis of the right ICA and critical stenosis (95 %) of the V1-segment of the left vertebral artery were also revealed. The operation was performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty, thrombectomy from the MCA and ACA pools. The end result is eTICI 2c reperfusion. There were no complications during this operation. The patient was discharged the next day (transferred to the neurological department at the place of residence). Control multispiral computed tomography of the brain showed positive dynamics (ASPECTS ‒ 1 point).D.V. ShcheglovV.N. ZahorodniiS.V. KonotopchikA.A. PastushinNAMS of Ukraine, State Organization "Scientific-Practical Center of Endovascular Neuroradiology, Non-Governmental Organization “All Ukrainian Association of Endovascular Neuroradiology, Shupyk National Healthcare University of Ukrainearticleacute thrombosis; tandem occlusions; thromboextraction.Medical physics. Medical radiology. Nuclear medicineR895-920ENRUUKУкраїнська Інтервенційна Нейрорадіологія та Хірургія, Vol 36, Iss 2, Pp 73-81 (2021)
institution DOAJ
collection DOAJ
language EN
RU
UK
topic acute thrombosis; tandem occlusions; thromboextraction.
Medical physics. Medical radiology. Nuclear medicine
R895-920
spellingShingle acute thrombosis; tandem occlusions; thromboextraction.
Medical physics. Medical radiology. Nuclear medicine
R895-920
D.V. Shcheglov
V.N. Zahorodnii
S.V. Konotopchik
A.A. Pastushin
Endovascular treatment of tandemic occlusions in acute ischemic stroke
description The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented. Man, 61 years old. He was delivered to the Center of endovascular neuroradiology, NAMS of Ukraine on January 15, 2021 with an ischemic stroke clinic in the left internal carotid artery basin. He fell ill acutely ‒ against the background of complete well-being, sensorimotor aphasia and right-sided hemiplegia appeared. Upon admission on the NIHSS (National Institutes of Health Stroke Scale) ‒ 18 points. On the performed initial multispiral computed tomography of the brain according to ASPECTS (Alberta Stroke Program Early CT score) ‒ 8 points. In the endovascular operating room, cerebral angiography was performed, followed by surgery aimed at restoring cerebral blood flow. The time from the onset of the disease to the puncture was 330 minutes, the duration of the operation was 135 minutes, thus the time from the onset of the disease to reperfusion was 465 minutes. Angiography revealed acute thrombosis of the left ICA starting from the orifice, M1-segment of the left MCA and A2-segment of the left ACA. Partial compensation of the basin through the supra-block anastomosis (external carotid artery ‒ ICA), as well as from the vertebro-basilar system through the network of leptomeningeal arteries. Collaterals ‒ ACG 3. Thrombosis of the right ICA and critical stenosis (95 %) of the V1-segment of the left vertebral artery were also revealed. The operation was performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty, thrombectomy from the MCA and ACA pools. The end result is eTICI 2c reperfusion. There were no complications during this operation. The patient was discharged the next day (transferred to the neurological department at the place of residence). Control multispiral computed tomography of the brain showed positive dynamics (ASPECTS ‒ 1 point).
format article
author D.V. Shcheglov
V.N. Zahorodnii
S.V. Konotopchik
A.A. Pastushin
author_facet D.V. Shcheglov
V.N. Zahorodnii
S.V. Konotopchik
A.A. Pastushin
author_sort D.V. Shcheglov
title Endovascular treatment of tandemic occlusions in acute ischemic stroke
title_short Endovascular treatment of tandemic occlusions in acute ischemic stroke
title_full Endovascular treatment of tandemic occlusions in acute ischemic stroke
title_fullStr Endovascular treatment of tandemic occlusions in acute ischemic stroke
title_full_unstemmed Endovascular treatment of tandemic occlusions in acute ischemic stroke
title_sort endovascular treatment of tandemic occlusions in acute ischemic stroke
publisher NAMS of Ukraine, State Organization "Scientific-Practical Center of Endovascular Neuroradiology, Non-Governmental Organization “All Ukrainian Association of Endovascular Neuroradiology, Shupyk National Healthcare University of Ukraine
publishDate 2021
url https://doaj.org/article/dab127de9fbb4b198010cd331fc6e3a1
work_keys_str_mv AT dvshcheglov endovasculartreatmentoftandemicocclusionsinacuteischemicstroke
AT vnzahorodnii endovasculartreatmentoftandemicocclusionsinacuteischemicstroke
AT svkonotopchik endovasculartreatmentoftandemicocclusionsinacuteischemicstroke
AT aapastushin endovasculartreatmentoftandemicocclusionsinacuteischemicstroke
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