Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: case report.

Abstract:

:Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thrombectomy was performed through percutaneous cervical ICA access due to the inability to cross the cervical carotid occlusion. Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasminogen activator (tPA) infusion. This case illustrates the shortest reported interval between tPA infusion and open surgical intervention for carotid revascularization, as well as the role of direct carotid artery access for mechanical thrombectomy. The authors also describe the use of a temporizing femoral artery-to-ICA shunt to maintain cerebral perfusion in the setting of ICA occlusion.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Frenkel MB,Renfrow JJ,Singh J,Garg N,Wolfe SQ

doi

10.3171/2017.6.JNS162368

subject

Has Abstract

pub_date

2018-09-01 00:00:00

pages

718-722

issue

3

eissn

0022-3085

issn

1933-0693

pii

2017.6.JNS162368

journal_volume

129

pub_type

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