J Cerebrovasc Endovasc Neurosurg.  2022 Jun;24(2):137-143. 10.7461/jcen.2021.E2021.07.014.

Clinical and radiological outcomes of mechanical thrombectomy in simultaneous anterior cerebral artery and middle cerebral artery occlusion

• Kim H
• Jin SC
• Lee H

• KMID: 2531656
• DOI: http://doi.org/10.7461/jcen.2021.E2021.07.014

Abstract

Objective
Simultaneous anterior cerebral artery (ACA) and middle cerebral artery (MCA) occlusion is rare. We investigated the clinical and radiological outcomes of patients with simultaneous ACA and MCA occlusion treated with mechanical thrombectomy.
Methods
We analyzed the clinical and radiological outcomes of 12 patients with simultaneous ACA and MCA occlusion treated with mechanical thrombectomy from January 2018 to December 2020. The clinical outcome was assessed using the modified Rankin Score (mRS) after 3 months of thrombectomy. The radiological outcome was assessed using the thrombolysis in cerebral infarction (TICI) score.
Results
The median National Institutes of Health Stroke Scale score at hospital arrival was 18 (interquartile range, 16–20). M1 was the most common occlusion lesion (n=8), and A3 was the most common lesion in the ACA (n=6). Six patients were first treated for MCA occlusion and later for ACA occlusion (MCA group). Other patients were first treated for ACA occlusion and later for MCA occlusion (ACA group). There was no difference in clinical outcomes between the MCA and ACA groups (p=0.180). Successful recanalization (TICI ≥2b) of MCA was achieved in 10 patients (83.3%). Successful recanalization of ACA was achieved in 10 patients (83.3%). Successful recanalization of both ACA and MCA occlusion was observed in eight patients (66.7%). Three patients (25%) had good clinical outcomes (mRS ≤2).
Conclusions
In our series, simultaneous ACA and MCA occlusion showed relatively poor successful recanalization rates and poor clinical outcomes despite treatment with mechanical thrombectomy.

Keyword

Thrombectomy; Ischemic stroke; Middle cerebral artery; Anterior cerebral artery

Figure

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  Fig. 1. (A) Brain computer tomography at arrival of hospital (ASPECT score was 9). (B) Computer tomography cerebral angiogram and brain perfusion computed tomography. The flow velocity is shown to decrease in the left middle cerebral artery territory. The volume is preserved in the inferior branch of the middle cerebral artery. (C) The occlusion lesions are M1 and A3 lesions in cerebral angiogram. (D) Hybrid mechanical thrombectomy of the middle cerebral artery. Stent retrieval using partial stent deployment in the anterior cerebral artery. (E) Magnetic resonance angiography after thrombectomy. (F) Brain computer tomography after thrombectomy. ASPECT, Alberta Stroke Programme Early CT

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