PMC7656013_01
(a) Magnetic resonance diffusion-weighted imaging at admission showed regions of high signal intensity in the left frontal lobe, parietal lobe, insular cortex, and corona radiata. (b) Magnetic resonance angiography showed occlusion of the left internal carotid artery (ICA) (white arrow) distal to a persistent primitive trigeminal artery (PPTA) (white arrow head). The vertebral arteries and posterior communicating arteries were hypoplastic bilaterally. The bilateral superior cerebellar and posterior cerebral arteries were fed by the left ICA through the PPTA.
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F1
The DWI Alberta Stroke Program Early Computed Tomographic Score was 5 [Figure 1a]. The vertebral arteries (VAs) and posterior communicating arteries (PCoAs) were hypoplastic bilaterally [Figure 1b].
(a) Digital subtraction angiography (DSA) showed occlusion of the left ICA (white arrow head) distal to a persistent primitive trigeminal artery (white arrow). (b) The Solitaire 4 x 20 mm stent retriever (Medtronic, Minneapolis, Minnesota, USA) (black arrow heads) was deployed. The Marksman microcatheter (Medtronic) was removed and the AXS Catalyst 6 (Stryker, Freemont, California, USA) (black arrow) was introduced proximal to the thrombus. The 9 Fr Optimo (Tokai Medical Products, Kasugai, Aichi, Japan) was inflated (white arrow heads) and the Solitaire and AXS Catalyst 6 were removed together. (c) Postoperative DSA showed complete recanalization of the left ICA (white arrow head).
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F2
The PPTA was feeding the BA and bilateral SCAs and posterior cerebral arteries (PCAs) [Figure 2a]. The Solitaire stent retriever and AXS Catalyst 6 were removed together [Figure 2b]. ENT did not occur [Figure 2c].
(a) Postoperative diffusion-weighted imaging showed no new cerebral infarction. (b) Postoperative magnetic resonance angiography showed complete recanalization of the left internal carotid artery (white arrow).
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F3
MRA showed patency of the left ICA and PPTA [Figure 3a and b].