Internal Carotid Artery Rupture during Mechanical Thrombectomy of Tandem Occlusion

Ariharan K.; Sharath Kumar G.G; Somasree Manna

doi:10.1055/s-0045-1805006

Journal of Clinical Interventional Radiology ISVIR, Table of Contents

CC BY 4.0 · Journal of Clinical Interventional Radiology ISVIR
DOI: 10.1055/s-0045-1805006

Case Report

Internal Carotid Artery Rupture during Mechanical Thrombectomy of Tandem Occlusion

Ariharan K.

¹Department of Neuroimaging and Interventional Radiology, First Neuro Hospital, Mangalore, Karnataka, India

,

Sharath Kumar G.G

²Department of Neuroimaging and Interventional Radiology, Apollo Hospital, Bangalore, Karnataka, India

,

Somasree Manna

³Department of Radiodiagnosis, Banaras Hindu University, Varanasi, Uttar Pradesh, India

› Author Affiliations

Abstract

Mechanical thrombectomy of tandem occlusion involving the internal carotid artery (ICA) is effective but complex. We discuss ICA rupture during thrombectomy of a tandem ICA occlusion. After crossing the ICA origin, manual angiography in the closed segment between proximal severe stenosis and distal thrombus leads to ICA rupture. The combination of high pressure created in a closed segment and weak structural points can lead to the rupture. The rupture can happen at the intradural segment of the ICA or an aneurysm. This complication may be avoided by an antegrade approach to tandem occlusions, low-flow microcatheter injections, and common carotid artery injections.

Keywords

ICA rupture - tandem occlusion - mechanical thrombectomy

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References

References
1 Anadani M, Spiotta A, Alawieh A. et al; TITAN (Thrombectomy In TANdem Lesions) Investigators. Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry. J Neurointerv Surg 2019; 11 (10) 970-974
2 Cora E, Arthur A, Schmidt M. et al. E-111 Intracranial carotid rupture during thrombectomy with effective tandem occlusion. J Neurointerv Surg 2020; 12: A89-A90
3 Watanabe S, Oda J, Nakahara I. et al. Experimental analysis of intra-luminal pressure by contrast injection during mechanical thrombectomy: simulation of rupture risk of hidden cerebral aneurysm in tandem occlusion with blind alley. Neurol Med Chir (Tokyo) 2020; 60 (06) 286-292
4 Freitas Lopes C, Lucas Neto L. Internal carotid artery rupture during endovascular thrombectomy in patients with tandem occlusion: a two-case report. Neuroradiol J 2024; 19714009241252624: 19 714009241252624
5 Masuoka T, Hayashi N, Hori E, Kuwayama N, Ohtani O, Endo S. Distribution of internal elastic lamina and external elastic lamina in the internal carotid artery: possible relationship with atherosclerosis. Neurol Med Chir (Tokyo) 2010; 50 (03) 179-182
6 Fox AJEM, Eliasziw M, Rothwell PM, Schmidt MH, Warlow CP, Barnett HJ. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am J Neuroradiol 2005; 26 (08) 2086-2094