PMC6350028_01
(A and B) Axial plain computed tomography showing an old infarction in the right occipital lobe and early ischemic change in the right middle frontal gyrus. (C) Axial contrast-enhanced computed tomography showing thrombus in the left superior pulmonary vein stump (arrow) and no evidence of an aortic dissection. (D and E) Pre- (D) and post- (E) treatment right internal carotid angiograms (frontal view). The superior trunk of the right middle cerebral artery is occluded (arrowhead), which was mechanically removed. The occluded middle cerebral artery was completely recanalized.
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F1
CT score (ASPECTS) of 9 (Figs. 1A and 1B). Contrast-enhanced CT indicated the right middle cerebral artery (MCA) occlusion and demonstrated no evidence of aortic dissection (Fig. 1C). Digital subtraction angiography (DSA) revealed that the right MCA was occluded at the proximal site of the superior trunk (Fig. 1D). The thrombolysis in cerebral infarction score was 3 and there were no stenotic lesions indicating atherosclerosis (Fig. 1E). The retrieved embolus was macroscopically red thrombus (Figs. 2A and 2B). Contrast-enhanced CT at hospital arrival was assessed retrospectively and the thrombus was detected in the same location as a contrast defect (Fig. 1C).
Macroscopic photograph (A and B) and histological findings (C-F) of the retrieved embolus. The retrieved embolus appears as dark-red structure, and considers to be red thrombus (A, entire view with the stent-retriever; B, enlarged view). hematoxylin-eosin staining (original magnification: C, x100; D, x400) and Elastica-Masson staining (original magnification: E, x100; F, x400) shows that the retrieved embolus primarily consists of fibrin and erythrocytes. Scale bars: 100 mum.
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F2
The thrombolysis in cerebral infarction score was 3 and there were no stenotic lesions indicating atherosclerosis (Fig. 1E). The retrieved embolus was macroscopically red thrombus (Figs. 2A and 2B). Histological examination with hematoxylin-eosin staining and Elastica-Masson staining revealed that the retrieved embolus consisted of both fibrin and erythrocyte-rich thrombus (Figs. 2C-2F).
Post-operative findings of the imaging studies. Transesophageal echocardiography 6 days after thrombectomy (A) shows thrombus (arrow) in the left superior pulmonary vein stump. Transesophageal echocardiography 18 days after thrombectomy (B) and contrast axial computed tomography 19 days after thrombectomy (C) reveal complete disappearance of the thrombus.
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F3
To further analyze the embolic source, transesophageal echocardiography was performed 6 days after thrombectomy, and a thrombus in the left superior pulmonary vein stump was detected (Fig. 3A). Follow-up transesophageal echocardiography 18 days after thrombectomy and contrast-enhanced CT 19 days after thrombectomy demonstrated that the thrombus completely disappeared (Figs. 3B and 3C).