Transbrachial access for mechanical thrombectomy in a case of acute ischemic stroke with aortic bifurcation occlusion

Abstract

Objective: To report successful mechanical thrombectomy through transbrachial route in a patient with left middle cerebral artery (MCA) stroke and aortic bifurcation occlusion. Background: Mechanical thrombectomy is the standard therapeutic approach for eligible candidates of acute ischemic stroke according to American Heart Association/American Stroke Association guidelines. Mostly, a transfemoral approach is used to perform mechanical thrombectomy. Few studies have shown use of radial route for this procedure. Few reports have shown alternate access routes for performing mechanical thrombectomy when transfemoral or radial routes are not accessible. Design/Methods: Case report and literature review. Results: A 51-year-old female presented with left MCA stroke. Computed tomography angiography showed left internal carotid artery T occlusion extending into left MCA. Associated left atrial thrombus and occlusion at the aortic bifurcation were diagnosed in this patient. A transbrachial route was taken to perform mechanical thrombectomy in this patient resulting in complete recanalization. Conclusion: This case emphasizes the role of alternate access routes to perform mechanical thrombectomy in challenging situations.