Mechanical Thrombectomy for Bihemispheric Infarction Caused by Acute Unilateral Internal Carotid Artery Occlusion in a Patient with Contralateral Chronic Carotid Occlusion: A Case Report.

Objective: We report a patient with acute bihemispheric infarction who underwent mechanical thrombectomy. Case Presentation: A 76-year-old man suddenly developed coma and quadriplegia. Brain MRI and MRA revealed acute bihemispheric infarction due to occlusions of both the internal carotid arteries (ICAs). According to the DSA findings, we considered the left ICA as chronic occlusion and the right as acute. Mechanical thrombectomy for the right ICA occlusion was performed. Total recanalization was achieved using a stent retriever 181 minutes after onset. The left hemisphere was perfused by cross circulation through the anterior communicating artery, but the symptoms did not improve. MRI the day after thrombectomy showed extensive bihemispheric infarction. Recanalization for the bilateral hemispheres was maintained, although the left ICA remained occluded. He died 2 months later due to gastrointestinal bleeding. Conclusion: Acute bihemispheric infarction due to occlusions of both ICAs is a rare entity. The symptoms are very severe and the therapeutic time window is extremely short because of absent collateral pathways. We should consider pre-existing carotid occlusive disease, determine whether the occlusions are acute or chronic, and perform prompt therapy. Further investigation is warranted to obtain a better outcome.

Retrograde T-Stent Technique for Large, Wide-Necked Internal Carotid-Posterior Communicating Artery Aneurysm.

Objective: We report a case of a wide-necked internal carotid-posterior communicating (IC-Pcom) artery aneurysm treated by the retrograde T-stent technique in which a stent was also placed in the Pcom artery via the posterior circulation. Case Presentation: A 35-year-old woman was diagnosed with an unruptured right IC-Pcom artery aneurysm (maximum diameter: 11 mm, neck diameter: 8.5 mm) during a detailed examination for vertigo. The Pcom artery (2.1 mm) branched from the aneurysmal dome. A microcatheter was guided in retrograde via the Pcom artery from the posterior circulation. A low-profile visualized intraluminal support (LVIS) Jr. 2.5 mm × 17 mm was deployed from the internal carotid artery (ICA) to the Pcom artery, and then, an LVIS 4.5 mm × 23 mm was deployed while pressing the flare of the LVIS Jr. protruding into the ICA. T configuration stenting was completed, and the coil was inserted as tightly as possible. Conclusion: The retrograde T-stent technique, which has the advantage of optimal stent positioning, is useful for preserving a Pcom artery branching from the aneurysmal dome.