J Cerebrovasc Endovasc Neurosurg.  2012 Jun;14(2):108-112. 10.7461/jcen.2012.14.2.108.

Mechanical Thrombolysis Using Coil in Acute Occlusion of Fenestrate M1 Segment

• Seo BS
• Lee YS
• Lee JH
• Lee HG
• Ryu KY
• Kang DG

• KMID: 1808446
• DOI: http://doi.org/10.7461/jcen.2012.14.2.108

Abstract

A fenestrated middle cerebral artery (MCA) is a rare congenital anomaly, and is related to interference in the normal embryonic development of the MCA. Fenestrated MCA has been regarded to have no clinical significance other than a rare event of hemorrhage from associated aneurysm. However, the fenestration within the arterial trunk can be an obstacle against thrombus migration and may be associated with a major cerebral infarction. Moreover, the presence of this anomaly can be hardly detected prior to thrombolytic procedures, and emergent treatments are proceeded without any information of anatomical configurations. Therefore, the recanalization procedures would carry a high risk of intraprocedural complications. We report a rare case of MCA territory infarction from occlusion of fenestrated M1 segment, and also introduce a safe method of mechanical thrombolysis using coil.

Keyword

Cerebral infarction; Middle cerebral artery; Fenestration

MeSH Terms

Aneurysm
Cerebral Infarction
Embryonic Development
Female
Hemorrhage
Infarction
Mechanical Thrombolysis
Middle Cerebral Artery
Pregnancy
Thrombosis

Figure

• 

  Fig. 1 (A) Diffusion-weighted image shows hyperintensity at right middle cerebral artery territory. (B) Magnetic resonance angiography demonstrates right. M1 occlusion.

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  Fig. 2 (A) Anterior-posterior view of right internal carotid angiogram shows right M1 occlusion. (B) Lateral view of right internal carotid angiogram reveals wide flow defect to the right middle cerebral artery territory. (C) The mechanical clot disruption was performed by simple to-and-fro maneuvers using coil. (D) Anterior-posterior view of right internal carotid angiogram shows remaining thrombus at the inferior portion of M1.

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  Fig. 3 (A) Follow-up angiogram after one month clearly demonstrates the anatomical contour of a fenestrated MCA. (B) The three-dimensional angiogram depicts the configuration of the fenestration with the temporopolar artery originating from distal M1.

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  Fig. 4 The illustration shows that the fenestration within the arterial trunk may act as an obstacle against thrombus migration and can possibly be the site of occlusion.

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