PMC8769465_01
(A and B) Head CT on admission; there were low-density areas in left cerebellum and left occital-temporal lobe. (C and D) Diffusion-weighted-image on head MRI revealed high-intensity areas. (E) Basilar tip or left PCA occlusion was suspected on MRA. (F) After sudden unconsciousness, incomplete BAO was revealed on CTA. BAO: basilar artery occlusion, CT: computed tomography, CTA: computed tomography angiography, MRA: magnetic resonance angiography, MRI: magnetic resonance imaging, PCA: posterior cerebral artery, SCA: superior cerebellar artery.
nmccrj-8-767-g001.jpg
PMC8769465_01_nmccrj-8-767-g001.jpg
F1
Magnetic resonance imaging (MRI) showed acute infarction in the left occipital and anterior lobes of the cerebellum (Fig. 1).
(A) Preoperative left vertebral artery angiography (anterior-posterior view) revealed the basilar tip occlusion and left PCA was not contrasted. (B) We withdrawn SOFIAFLOW into the guiding catheter (ENVOY) (ADAPT technique). (C) Successful recanalization of basilar artery was obtained after thrombectomy (anterior-posterior view). (D-G) Postoperative head MRI and CT revealed new infarction in bilateral midbrain and thalamus medialis. ADAPT: a direct aspiration first-pass technique, CT: computed tomography, MRI: magnetic resonance imaging, PCA: posterior cerebral artery.
nmccrj-8-767-g002.jpg
PMC8769465_01_nmccrj-8-767-g002.jpg
F2
The microwire and microcatheter were removed, and aspiration was performed through an aspiration syringe and withdrawn into the guiding catheter (Fig. 2). The next day, MRI revealed high-intensity areas in the midbrain and bilateral thalamus, and infarctions of perforating arteries (i.e., posterior thalamic perforating arteries) from the basilar artery tip (Fig. 2).
(A and B) Hematoxylin and eosin stain of obtained emboli showed the emboli constituted mainly with fibrin. Interestingly, the thrombi contained many deformed blast cells. (C) Bone marrow revealed over 99% positive cells with peroxidase stain.
nmccrj-8-767-g003.jpg
PMC8769465_01_nmccrj-8-767-g003.jpg
F3
These obtained thrombi were mainly composed of fibrin but also contained leukemic blasts (Fig. 3A and 3B). Therefore, hematologists diagnosed as AML not otherwise specified without mutation according to the World Health Organization's classification of AML and as M1 according to the French-American-British classification of AML (Fig. 3).