Interdisciplinary Neurosurgery (Dec 2021)
Anterior cerebral artery thrombectomy: A case series and technical description
Abstract
Background: Distal medium vessel occlusions account for 25–40% of ischemic stroke. The utility of thrombectomy in these vessel territories is less frequently studied. Objective: This paper describes a focused series of ACA thrombectomies performed with consistent technique, catheters, and devices. Methods: A prospectively maintained single interventionalist endovascular thrombectomy database was queried from 7/2016 to 2/2021 for ACA thrombectomy cases. Demographics, comorbidities, equipment utilized, and clinical/angiographic outcomes were obtained. Cohort comparisons between primary ACA thrombectomy cases and nonprimary cases were performed using a 2-tailed t-test for numerical variables and a Fisher’s Exact test for categorical variables. Results: Successful reperfusion with respect to the ACA occlusion (TICI 2b-3) was achieved in seven cases overall (78%). In all cases of primary ACA occlusion, successful reperfusion was achieved (3/3). Ninety day mRS of 0–3 was achieved in 2/3 of cases of primary ACA thrombectomy (67%) as compared to no cases of nonprimary ACA occlusion. Conclusions: In this report, we describe a consistent, simple, and reproducible thrombectomy technique in the anterior cerebral artery. Though successful reperfusion was achieved in most cases for the ACA, clinical outcomes were less encouraging for patients undergoing ACA thrombectomy with either concomitant MCA occlusions or initial ICA occlusions.
