Stent-Retriever Stenosis in Middle Cerebral Arteries after Endovascular Thrombectomy

Introduction The purpose of this study is to add to the conflicting literature surrounding the relationship between stent‐retrievers and post‐endovascular thrombectomy (EVT) stenosis. EVT using a stent‐retriever to mechanically remove embolisms is the standard to treat large vessel occlusions. Recurrent stenosis is not uncommon, and it is theorized that the mechanical stress exhibited by the stent‐retriever can cause irritation of the vessel walls resulting in thrombosis and re‐occlusion causing post‐EVT stenosis. Large‐bore aspiration catheters are an alternative method and have been found to possibly reduce the risk of post‐EVT stenosis. Materials/Methods A 72‐year‐old male with a history of atrial fibrillation, off anticoagulation due to complex femoral‐peroneal bypass surgery, presented with left hemiparesis and dysarthria. A computed tomography angiography (CTA) demonstrated occlusion of the right middle cerebral artery (MCA) in the M1 segment with severe stenosis of the left MCA (Figure 1). The patient underwent successful EVT via right common femoral artery access, with complete recanalization after one pass of aspiration. Four months previously, the patient presented with right side hemiparesis and dysarthria and was found to have a left MCA M1 occlusion. He underwent EVT using a stent‐retriever technique with 1 pass and a 5 mm x 37 mm stent was deployed, resulting in complete recanalization. On the post‐EVT control angiogram there was no significant stenosis in the left MCA. Results The same patient underwent EVT within 4 months in both the left and right MCA and developed left progressive MCA stenosis post stent‐retriever thrombectomy. While the type of stroke mechanisms could be another factor, this patient's case adds to the conflicting literature surrounding stent‐retrievers and a higher frequency of re‐occlusion as compared to aspiration. Conclusion Post‐EVT stenosis can cause further complications, such as stroke, and thus this case warrants research to elucidate the relationship of stent‐retrievers and post‐EVT stenosis.