PMC10370524_01
(A) In the anterior view, preoperative 3D CTA showed that flexion of the aorta and the angle between left common carotid artery (white arrow) and the aortic arch were very steep. (B) In the posterior view, an artificial vascular stent was placed in the thoracoabdominal aorta and a thoracoabdominal aortic aneurysm was also observed.
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F1
After tPA infusion, CTA performed following MRA showed a type III arch in the aortic arch and severe tortuosity of the thoracoabdominal aorta (Fig. 1A and 1B); therefore, angiography was performed using the transbrachial approach.
Postoperative findings in the imaging studies. (A) On day 1, echocardiography revealed a 17-mm thrombus in the left atrial appendage (white arrow). (B) After MT, the thrombus in the left atrial appendage had disappeared on day 7. MT: mechanical thrombectomy
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F2
On the first day of admission, echocardiography revealed a 17-mm thrombus in the left atrial appendage (Fig. 2A); thus, anticoagulation with warfarin was increased from 3 mg to 3.5 mg based on the INR. After MT, consciousness disturbance and left paralysis improved promptly, and the thrombus found in the left atrial appendage disappeared due to postoperative anticoagulant therapy on the seventh day (Fig. 2B).
(A-C) On day 6, DWI showed a high-intensity area in the right insular cortex and deep white matter; T2-weighted imaging showed a low-intensity area (black arrow) in the right ICA; and MRA showed right ICA occlusion. (D) In the anterior view, the transbrachial approach was selected again, and cerebral angiography before MT showed right carotid artery occlusion. (E and F) In the anterior view, we performed MT using a combined technique with a stent retriever (white arrowheads) and an aspiration catheter (black arrowhead). (G) Angiogram after MT showed complete recanalization of the right ICA (TICI 3). DWI: diffusion-weighted imaging; ICA: internal carotid artery; MT: mechanical thrombectomy; TICI: thrombolysis in cerebral infarction
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F3
DWI-MRI showed a hyperintense area in the right insular cortex, and MRA showed an occlusion of the right internal carotid artery (ICA) (Fig. 3A-3C). Angiogram showed poor visualization of the ICA (Fig. 3D and 3E). The Solitaire 6 mm/41 mm (Medtronic) was fully deployed using the push and fluff technique over the thrombus (Fig. 3F). Complete recanalization was achieved on the first pass (Fig. 3G), and the procedure was finished after hemostasis of the puncture site using a compression device for 10 hours.
On 30 days after MT, no local complications were found in the puncture site. MT: mechanical thrombectomy
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F4
No obvious puncture site complications were observed on the 30 days (Fig. 4).