Mechanical Thrombectomy for Acute Medium Vessel Occlusion Because of Paradoxical Cerebral Embolism in a Patient with a Right Aortic Arch: A Case Report.

Journal of neuroendovascular therapy Pub Date : 2025-01-01 Epub Date: 2025-03-29 DOI:10.5797/jnet.cr.2024-0092
Akihiro Niwa, Yoshihiro Omura, Takahiro Yokoyama, Qian Bohui, Ryo Saito, Oji Momosaki, Shunsuke Nomura, Akitsugu Kawashima, Takakazu Kawamata
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Abstract

Objective: Right aortic arch is a rare congenital anomaly. We report a case of mechanical thrombectomy for acute left medium-vessel occlusion due to a paradoxical embolism in a patient with a right aortic arch.

Case presentation: An 81-year-old woman presented with severe right-sided hemiparesis and aphasia. The National Institutes of Health Stroke Scale score was 16, MRI demonstrated a diffusion-weighted imaging Alberta Stroke Program Early CT score of 7, and MRA revealed left M2 occlusion. CTA revealed a right aortic arch with mirror image branching. Mechanical thrombectomy was conducted using the usual system, and effective recanalization was achieved with a stent retriever and aspiration catheter after 3 passes. CTA revealed pulmonary embolism and deep vein thrombosis (DVT) in the right deep femoral vein, and transesophageal echocardiography demonstrated a patent foramen ovale. Electrocardiography did not reveal atrial fibrillation, and other examinations did not reveal any other cause; therefore, a paradoxical cerebral embolism was diagnosed. After anticoagulant therapy, no recurrence of infarction, pulmonary embolism, or DVT was observed. Severe right hemiparesis and total aphasia did not improve, and the patient was discharged on day 37 after admission with a modified Rankin Scale score of 5.

Conclusion: Access to the left common carotid artery in right aortic arch cases can be anatomically challenging. Preoperative imaging evaluation of the access route is crucial for quick and safe mechanical thrombectomy.

机械取栓治疗右主动脉弓患者因异位性脑栓塞引起的急性中血管闭塞1例。
目的:右主动脉弓是一种罕见的先天性畸形:右主动脉弓是一种罕见的先天性畸形。我们报告了一例右主动脉弓患者因矛盾性栓塞导致急性左侧中血管闭塞而进行机械取栓术的病例:一名81岁的女性患者出现严重的右侧偏瘫和失语。美国国立卫生研究院卒中量表评分为 16 分,核磁共振成像显示弥散加权成像阿尔伯塔卒中项目早期 CT 评分为 7 分,MRA 显示左侧 M2 闭塞。CTA显示右主动脉弓有镜像分支。患者使用常规系统进行了机械血栓切除术,并在使用支架回取器和抽吸导管 3 次后实现了有效再通畅。CTA显示右股深静脉存在肺栓塞和深静脉血栓(DVT),经食道超声心动图显示卵圆孔未闭。心电图检查未发现心房颤动,其他检查也未发现任何其他原因,因此诊断为矛盾性脑栓塞。经过抗凝治疗后,没有再发生脑梗塞、肺栓塞或深静脉血栓。严重的右侧偏瘫和完全性失语没有得到改善,患者于入院后第 37 天出院,修改后的 Rankin 量表评分为 5.结论:右主动脉弓病例的左颈总动脉入路在解剖学上具有挑战性。结论:右侧主动脉弓病例的左侧颈总动脉入路在解剖学上具有挑战性,术前对入路进行成像评估对于快速、安全地进行机械取栓至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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