Journal of neuroendovascular therapy最新文献

{"title":"Factors of Difficult Guiding Catheter Access in Mechanical Thrombectomy for Acute Ischemic Stroke in the Anterior Circulation.","authors":"Kazuhiro Ando, Bumpei Kikuchi, Jun Watanabe, Toru Takino, Yoshihiro Mouri, Yuki Watabe, Kazuki Shida, Shinya Yamashita","doi":"10.5797/jnet.oa.2024-0108","DOIUrl":"https://doi.org/10.5797/jnet.oa.2024-0108","url":null,"abstract":"<p><strong>Objective: </strong>Insertion of a guiding catheter (GC) system into the desired arterial site is crucial in mechanical thrombectomy (MT). This study assessed the factors of difficult GC access to the target carotid artery in patients with acute ischemic stroke in the anterior circulation.</p><p><strong>Methods: </strong>In total, 174 patients who had undergone MT were retrospectively reviewed. The incidence of patients who could not undergo GC insertion to the target carotid artery, as well as the characteristics and outcomes of patients requiring a longer groin puncture-to-GC insertion time, were examined. The patients were divided into 3 groups based on the time from groin puncture to insertion into the target carotid artery: group A, within 10 min; group B, within 10-20 min; and group C, >20 min. In this study, the transfemoral catheter access was the primary option, and the approach site was changed based on the operator's discretion. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction grade ≥2B. A favorable outcome was defined as a modified Rankin Scale score of 0-2.</p><p><strong>Results: </strong>Catheterization of the target carotid artery could not be performed in 8 (4.6%) patients, who were older and more likely to be female. The proportion of patients with a height ≤150 cm and the percentage of patients with a type III arch and/or tortuous common carotid artery (CCA) were high. The approach was changed in 4 (2.3%) patients, and GC insertion was successful in all cases. A significant difference was observed among the 3 groups in terms of age and the percentage of patients with a type III arch and/or CCA tortuosity and internal carotid artery occlusion. In addition, the time from groin puncture to recanalization significantly differed. The recanalization rate and the 90-day favorable outcome rate were significantly lower in patients with a groin puncture-to-GC insertion time >20 min.</p><p><strong>Conclusion: </strong>We need to make an effort to insert the GC within 20 min while actively considering changes in the approach, particularly in older patients and those with a type III arch and/or tortuous CCA.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Updated Review on the Pathogenesis of Brain Arteriovenous Malformations and Its Therapeutic Targets.","authors":"Takahiro Ota","doi":"10.5797/jnet.ra.2024-0008","DOIUrl":"10.5797/jnet.ra.2024-0008","url":null,"abstract":"<p><p>Brain arteriovenous malformations (bAVMs) are associated with a high risk of intracerebral hemorrhage, which causes severe complications in patients. Although the genetic factors leading to hereditary bAVMs have been extensively investigated, their pathogenesis are still under study. This review examines updated data on the molecular and genetic aspects of bAVMs, the architecture of microvasculature, the roles of angiogenic factors, and signaling pathways. The compiled information may help us understand the pathogenesis of both sporadic and hereditary bAVMs and develop appropriate preemptive treatment approaches.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sphenoid Wing Dural Arteriovenous Fistulas.","authors":"Naoki Akioka, Naoya Kuwayama, Satoshi Kuroda","doi":"10.5797/jnet.ra.2023-0034","DOIUrl":"10.5797/jnet.ra.2023-0034","url":null,"abstract":"<p><p>The sphenoid wing dural arteriovenous fistulas (DAVFs) are clinically rare. They often present as non-sinus-type arteriovenous fistulas (AVFs) and may be associated with focal neurological deficits, intracranial venous hypertension, and intracranial hemorrhage. These cases are classified as lesser or greater sphenoid wing lesions. We searched the PubMed databases for studies evaluating the clinical presentation, surgical treatment, and endovascular treatment of these lesions and analyzed 37 cases from 22 papers. A total of 17 cases had lesser sphenoid wing AVFs, and the localization of the shunts could be divided into the sinus of the lesser sphenoid wing (SLSW) or the superficial middle cerebral vein (SMCV). Most SLSW AVFs drained into the cavernous sinus, but two cases drained directly into the deep middle cerebral vein via a bridging vein. All cases with shunts directly into the SMCV had reflux into the SMCV with varices. A total of 20 cases had shunts in the greater sphenoid wing, and the localization of the shunts varied, with shunt localization, and venous return morphology dependent on variations in middle fossa venous return. Most cases had shunts in the sphenobasal vein near the foramen ovale. However, some cases had shunts in the superior ophthalmic vein, sphenopetrosal vein, and laterocavernous sinus. Many were associated with cortical venous reflux. These lesions have been treated by surgical ligation of the drainage vein and transarterial or transvenous embolization. Recently, embolization has become the standard treatment for DAVFs due to advances in endovascular techniques. This paper reviewed and discussed the angioarchitecture, clinical presentation, and treatment of these lesions to clarify the characteristics of sphenoid wing DAVFs.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Acute Ischemic Stroke due to Tandem Lesion Treated with Endovascular Thrombectomy by Internal Carotid Artery Direct Puncture.","authors":"Taro Kusakabe, Yutaka Fukushima, Shinichiro Yoshino, Katsuyuki Hirakawa, Yoshinobu Horio, Hiroshi Abe","doi":"10.5797/jnet.cr.2024-0087","DOIUrl":"10.5797/jnet.cr.2024-0087","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular thrombectomy is widely performed for acute ischemic stroke due to proximal intracranial artery occlusion. The femoral artery is often selected for puncture. However, common carotid artery puncture may be considered in more challenging cases. When the internal carotid artery is occluded or obstructed by atherosclerosis, puncturing the distal internal carotid artery becomes necessary. This is rare and was reported in only 2 cases. We report here a case of endovascular thrombectomy using direct puncture of the internal carotid artery.</p><p><strong>Case presentation: </strong>A 76-year-old male presented with sudden-onset right upper limb hemiparesis and mild dysarthria. Hospital admittance 1 hour later. Diffusion-weighted imaging (DWI) on head MRI revealed a hyperintense area in the left basal ganglia and corona radiata. MRA showed occlusion of the left internal carotid artery and the M2 segment of the left middle cerebral artery. Intravenous tissue plasminogen activator (tPA) was initiated, and endovascular thrombectomy was attempted. However, navigating the occluded left internal carotid artery was impossible. Symptomatic improvement was observed with tPA therapy causing recanalization of the M2 segment. Thus, further treatment was halted. Two days later, aphasia and complete right hemiparesis developed. MRA revealed no left anterior circulation flow. Under general anesthesia, an incision parallel to the left sternocleidomastoid muscle was made, and a direct puncture of the left internal carotid artery was performed to complete thrombectomy.</p><p><strong>Conclusion: </strong>In difficult-to-access cases, especially when considering puncturing the cervical vessels, our report suggests that exposing the cervical vessels first can improve the hemostasis and puncture performance.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Thrombectomy for Methamphetamine-Associated Cardiomyopathy with Left Ventricular Thrombus: A Case Report.","authors":"Tomohiro Fujioka, Kyoko Higashida, Naoki Hatayama, Nozomi Nagashima, Yuki Shimada, Isao Fukasaka, Mikito Shimizu, Hiroyuki Sumikura, Taku Hoshi, Junji Takasugi, Manabu Sakaguchi","doi":"10.5797/jnet.cr.2025-0003","DOIUrl":"10.5797/jnet.cr.2025-0003","url":null,"abstract":"<p><strong>Objective: </strong>The global increase in methamphetamine abuse has increased the incidence of methamphetamine-associated cardiomyopathy (MACM), which is often complicated by left ventricular thrombosis and acute ischemic stroke. Here, we report a case of left internal carotid artery occlusion during acute heart failure treatment in a patient with MACM that led to mechanical thrombectomy.</p><p><strong>Case presentation: </strong>A 54-year-old man with a history of approximately 30 years of methamphetamine abuse presented with dilated cardiomyopathy complicated by a left ventricular thrombus. On the night of admission for acute heart failure management, he experienced a sudden onset of consciousness disturbance, severe aphasia, and right hemiparesis. MRI revealed mild hyperintensities in the left cerebral hemisphere cortex and lenticular nucleus on diffusion-weighted imaging, with no abnormal signals on fluid-attenuated inversion recovery. He underwent mechanical thrombectomy, achieving complete reperfusion within 150 min; however, he experienced ipsilateral cerebral hyperemia that persisted for 30 days postoperatively. By the 90th postoperative day, moderate aphasia and mild paralysis of the right upper limb remained, with a modified Rankin Scale score of 3.</p><p><strong>Conclusion: </strong>Left ventricular thrombosis is relatively common in patients with MACM, necessitating careful consideration of the risk of cardioembolic stroke.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Submucosal Esophageal Hematoma: A Rare Hemorrhagic Complication Following Neuroendovascular Therapy.","authors":"Yoshitaka Yamaguchi, Kei Miyata, Tatsuro Takada, Fumiki Tomeoka, Minoru Ajiki","doi":"10.5797/jnet.cr.2025-0010","DOIUrl":"10.5797/jnet.cr.2025-0010","url":null,"abstract":"<p><strong>Objective: </strong>Submucosal esophageal hematoma (SEH) is a rare complication of neuroendovascular therapy, and there are insufficient data on the management of antithrombotic therapy in cases of SEH. We report a case of SEH following flow diverter stenting for an unruptured cerebral aneurysm, successfully managed with conservative treatment, including short-term interruption of antiplatelet therapy.</p><p><strong>Case presentation: </strong>An 80-year-old woman on clopidogrel and aspirin underwent Pipeline flow diversion with adjunctive coil embolization for an unruptured right internal carotid-posterior communicating artery aneurysm under general anesthesia without complications. Postoperatively, the patient developed chest pain, and CT revealed wall thickening from the middle to lower esophagus, leading to a diagnosis of SEH. SEH in this case was likely caused by a combination of antiplatelet therapy, anticoagulants, nasogastric tube insertion, and mechanical stimulation from intubation and extubation during the operation. The patient was managed conservatively with fasting and discontinuation of antiplatelet therapy. After CT confirmed hemostasis, antiplatelet therapy was resumed with intravenous ozagrel sodium on postoperative day 3, switching to oral prasugrel on day 7. Upper gastrointestinal endoscopy (UGE) on day 8 showed the submucosal hematoma replaced by ulcers and fistula formation. UGE on day 15 showed improvement, and CT on day 23 confirmed hematoma resolution. The patient was discharged on day 24 without symptoms or complications.</p><p><strong>Conclusion: </strong>In addition to previously reported cases, the presented case suggests that conservative management with temporary antiplatelet interruption and early resumption after hemostasis can lead to favorable outcomes in SEH cases associated with neuroendovascular therapy requiring antiplatelet therapy.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic Therapy for Acute Coronary Syndrome.","authors":"Toshiaki Toyota, Hirotoshi Watanabe, Kitae Kim, Yutaka Furukawa, Takeshi Kimura","doi":"10.5797/jnet.ra.2024-0102","DOIUrl":"10.5797/jnet.ra.2024-0102","url":null,"abstract":"<p><p>Acute coronary syndrome (ACS) encompasses a spectrum of cardiovascular emergencies, including unstable angina and myocardial infarction, that require immediate and effective management to reduce morbidity and mortality. Antithrombotic therapy, including antiplatelet and anticoagulant medications, is fundamental in ACS management. We sought to organize the current status of antithrombotic management of ACS, including the concept of high bleeding risk (HBR), in line with the clinical diagnostic flow. ACS is an ever-changing condition; therefore, its diagnosis and treatment are conducted in parallel. While primarily a coronary artery disease, the diagnosis of ACS also includes conditions such as myocardial infarction with nonobstructive coronary arteries as a working diagnosis. This review collates the mechanisms and classification of ACS, showing the diagnostic flow and the antithrombotic agents used at each stage. It discusses strategies for dual antiplatelet therapy (DAPT) duration and de-escalation in patients undergoing percutaneous coronary intervention and addresses the management of patients requiring oral anticoagulation alongside antiplatelet therapy, highlighting the shift toward dual therapy to reduce bleeding risk. Antithrombotic agents are key treatments for ACS, with various available options. Their mechanisms and the approved dosing regimens differ regionally, especially between Japan and other countries. This review synthesizes the regional availability of each agent and compares the latest recommendations from Japanese and international guidelines for ACS management. The field of antithrombotic therapy in ACS is dynamic, influenced by the findings of ongoing clinical trials and emerging evidence. Key considerations include balancing antithrombotic benefits against bleeding risks, particularly in patients with HBR. Recent studies have explored shorter DAPT durations and novel antithrombotic agents, offering new insights for diverse patient populations. In this review, we provide a comprehensive comparison of guidelines and insights from the neuro-interventional field to assist clinicians in making informed decisions regarding ACS management. As ACS management evolves, continued international, cross-sectional collaboration and research are essential to refine guidelines and improve clinical practice.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aneurysms Associated with Hyperplastic Anterior Choroidal Arteries: Three Cases with Literature Review.","authors":"Takahiro Uno, Katsunori Asai, Tomoki Kidani, Yoshitsugu Nishijima, Takaaki Matsumoto, Masayoshi Kida, Mao Kanechi, Yosuke Fujimi, Koji Kobayashi, Hideki Kuroda, Shuhei Kawabata, Nobuyuki Izutsu, Yonehiro Kanemura, Toshiyuki Fujinaka","doi":"10.5797/jnet.cr.2024-0097","DOIUrl":"10.5797/jnet.cr.2024-0097","url":null,"abstract":"<p><strong>Objective: </strong>A hyperplastic anterior choroidal artery (AchA) is a rare anomalous vessel that perfuses the posteromedial aspects of the cerebrum in place of the posterior cerebral artery. We describe 3 cases of hyperplastic AchA found among 61 patients with AchA aneurysms who underwent surgical or endovascular treatment at our institution.</p><p><strong>Case presentation: </strong>All 3 cases were diagnosed as hyperplastic AchA type 2 according to the Takahashi classification, indicating an anomalous branching temporal artery perfusing the medial temporal lobe. We performed coil embolization for 2 cases and surgical clipping for the third. One embolization case experienced recurrence after 3 years and underwent clipping. All procedures were conducted without complications.</p><p><strong>Conclusion: </strong>Hyperplastic AchA can be encountered during aneurysm treatment. These cases emphasize the importance of evaluating the vascular anatomy to determine the optimal treatment strategy.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortical Venous Approach for Transvenous Embolization of a Greater Sphenoid Wing Dural Arteriovenous Fistula: A Case Report.","authors":"Kenji Yamada, Masashi Ikota, Nozomi Ishijima, Yoshikazu Yoshino","doi":"10.5797/jnet.cr.2024-0071","DOIUrl":"10.5797/jnet.cr.2024-0071","url":null,"abstract":"<p><strong>Objective: </strong>Dural arteriovenous fistulas (dAVFs) in the paracavernous sinus of the sphenoid wing often present challenges for transvenous access because of their complex venous drainage patterns. Herein, we report the successful diagnosis and treatment of a greater sphenoid wing dAVF using a percutaneous transvenous approach via the Labbé vein.</p><p><strong>Case presentation: </strong>A 48-year-old woman presented with tinnitus and was diagnosed with a greater sphenoid wing dAVF. The dAVF was fed by multiple meningeal arteries from the accessory meningeal artery. Shunted blood drained retrogradely into the superficial middle cerebral vein (SMCV) and bilateral inferior petrosal sinus (IPS) via the cavernous sinus (CS). Although communication was observed between the shunt pouch and the lateral part of the CS, the tortuous and narrow nature of this connection suggests difficulty in accessing the shunt pouch via the IPS. Conversely, the SMCV, which served as the primary outflow pathway, was adequately connected to the vein of Labbé with minimal difficulty, facilitating the passage of the microcatheter. The percutaneous transvenous approach via the Labbé vein successfully reached the SMCV and achieved complete obliteration with selective transvenous embolization (TVE) using coils. The symptoms of the patient improved postoperatively, and the patient was discharged without complications.</p><p><strong>Conclusion: </strong>Greater sphenoid wing dAVFs often rely on the SMCV as the major drainage route, making venous approaches challenging. The route via the vein of Labbé through the cortical veins to reach the SMCV proved to be a valuable access route for TVE of greater sphenoid wing dAVFs.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Thrombectomy for Acute Medium Vessel Occlusion Because of Paradoxical Cerebral Embolism in a Patient with a Right Aortic Arch: A Case Report.","authors":"Akihiro Niwa, Yoshihiro Omura, Takahiro Yokoyama, Qian Bohui, Ryo Saito, Oji Momosaki, Shunsuke Nomura, Akitsugu Kawashima, Takakazu Kawamata","doi":"10.5797/jnet.cr.2024-0092","DOIUrl":"10.5797/jnet.cr.2024-0092","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}