Percutaneous Angioplasty and Mechanical Thrombectomy for Middle Cerebral Artery Occlusion Due to Intracranial Internal Carotid Artery Stenosis: Case Report

We report a case of middle cerebral artery (MCA) occlusion with intracranial internal carotid artery (ICA) stenosis in a patient who underwent percutaneous transluminal angioplasty (PTA) and thrombectomy.A 73-year-old man with right hemiparesis and aphasia was brought to our hospital by ambulance, 280 minutes after symptom onset. Diffusion-weighted imaging (DWI) showed acute infarction of the left caudate lenticular nucleus, insular cortex, frontal lobe, and corona radiata. Magnetic resonance angiography (MRA) showed left MCA occlusion and left intracranial ICA stenosis. We performed PTA for intracranial ICA stenosis initially, and then performed thrombectomy. Finally, we achieved successful recanalization (Thrombolysis in Cerebral Infarction grade 3). After interventional therapy, the right hemiparesis and aphasia improved. The modified Rankin scale score was 1 at 3 months after onset. Restenosis of the intracranial ICA was detected on digital subtraction angiography (DSA) and MRA after 3 months. Because no further progression of stenosis was observed after 6 months, we continued medical therapy and close follow-up.Emergency PTA and subsequent thrombectomy were comparatively safe and useful. However, the risks of recurrence and restenosis are problematic. Strict medical therapy and imaging follow-up are needed.