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Endovascular Mechanical Thrombectomy for Right Hemispheric Stroke Syndrome Due to Acute Left A1-A2 Junction Thromboembolic Occlusion

Tyler Scullen, James Milburn, Mansour Mathkour and Peter S. Amenta
Ochsner Journal December 2023, 23 (4) 347-352; DOI: https://doi.org/10.31486/toj.23.0042

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Figures

  • Figure 1.
    Figure 1.

    (A) Coronal computed tomography (CT) angiography of the head demonstrates short segment occlusion of the right supraclinoid segment of the internal carotid artery (arrow). (B) Axial view shows collateral flow from contralateral anterior circulation across the anterior communicating artery (arrow). (C) The bilateral middle cerebral arteries fill completely on axial CT angiography without branch occlusions (arrows), as does (D) the right posterior cerebral artery through the anterior communicating artery (arrow).

  • Figure 2.
    Figure 2.

    Computed tomography perfusion scan of the brain shows (A) increased mean transit times (MTT) in right middle cerebral artery territory and (B) normal symmetric cerebral blood volumes (CBV), indicative of a large penumbra.

  • Figure 3.
    Figure 3.

    Lateral digital subtraction angiography (DSA) of the right internal carotid artery shows (A) chronic occlusion of the communicating segment of the right internal carotid artery (arrow) and retrograde flash filling of the basilar artery (double arrows) via the posterior communicating artery. (B) Mid-arterial phase shows leptomeningeal collateral flow from the splenial branch of the posterior cerebral artery (arrow) to the pericallosal branch of the anterior cerebral artery (double arrows) that fills retrograde, as well as leptomeningeal collateralization (C) between the middle cerebral artery (arrow) and proximal anterior cerebral artery (double arrows). (D) Anteroposterior DSA right internal carotid artery injection shows dominance of the internal carotid artery in perfusing the vertebrobasilar system (double arrowheads) via retrograde flow of the right posterior cerebral artery P1 segment (arrow).

  • Figure 4.
    Figure 4.

    Anteroposterior digital subtraction angiography of the left internal carotid artery demonstrates (A) acute occlusion of the left A1-A2 junction (arrow). (B) Postthrombectomy injection demonstrates recanalization of left A1-A2 junction, bilateral anterior cerebral arteries, and bilateral middle cerebral arteries (arrows).

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