Mechanical thrombectomy via chronic occluded proximal artery for the endovascular treatment of acute ischemic stroke patients with large vessel occlusion.

BACKGROUND

Mechanical thrombectomy (MT) can significantly improve the prognosis of acute ischemic stroke patients with large vessel occlusion. However, for patients with chronic occluded proximal artery, therapeutical strategies are limited because the endovascular route for MT is not readily accessible.

METHODS

Here, we introduce a safe and effective MT procedure via a chronic occluded proximal artery. We conducted a retrospective study of seven patients with acute ischemic stroke due to large artery occlusion (AIS-LVO) who underwent MT via a chronic occluded proximal artery for endovascular treatment. We analyzed the technical procedure of the MT and the clinical outcomes of these patients.

RESULTS

The distal thrombus was successfully removed in all patients by opening the occluded proximal artery, thus achieving revascularization with a Thrombolysis in Cerebral Infarction (TICI) of 2b/3. The average time from arterial puncture to reperfusion was 171.14 ± 36.56 min. Three patients had a good modified Rankin scale (mRS) score (0-2) at discharge. Among 4 patients with anterior circulation stroke, 2 recovered completely, 1 had anomic aphasia, and 1 had hemiplegia. Among 3 patients with posterior circulation stroke, 1 recovered completely, 1 had locked-in syndrome, and 1 was comatose. Four patients had good functional prognoses.

CONCLUSIONS

Mechanical thrombectomy procedure via a chronic occluded proximal artery can be used in patients with well-established collateral compensatory vessels. It is safe and effective in improving the prognosis of patients. It can be used as a remedial treatment strategy for patients with AIS-LVO.