Summary a case of endovascular treatment of a patient with tandem occlusions of cerebral arteries caused by a mine-explosive injury

Abstract

One case of successful endovascular treatment of a patient with a mine blast injury is presented, which due to the action of the blast wave led to traumatic dissection of the internal carotid artery and the right anterior cerebral artery, which in turn led to the development of a secondary ischemic stroke. The patient is a combatant, a 59-year-old man. During the artillery shelling of the position, he was thrown back by the explosive wave and briefly lost consciousness. Upon regaining consciousness, within two hours there was weakness and decreased sensation in the left limbs, which completely regressed, but cognitive impairment and communication problems were observed. Computed tomography of the brain performed in the hospital closest to the hostilities did not reveal any pathological changes. Two days later, the patient was taken to the Dnipropetrovsk Regional Hospital named after I.I. Mechnikov. Repeated computed tomography revealed a small infarct in the basin of Heubner's right artery. Cerebral angiography (CT angiography and subtraction selective cerebral angiography) revealed a short occlusion of the right internal carotid artery from its ostium to the upper border of its bulb, and lack of contrast of the A1-segment of the right anterior cerebral artery. Changes on the CT perfusion maps indicated critical oligemia in the entire basin area of the right middle cerebral artery. The patient at hospitalization is conscious, with preserved movements and sensitivity. However, the patient has significant cognitive decline (MoCA (Montreal Cognitive Assessment Scale) 17). After double antiplatelet preparation, endovascular recanalization and stenting of the occluded right internal carotid artery was performed via transfemoral access using combined proximal and distal antiembolic protection (Cello 9F balloon guide catheter and SpiderFX distal antiembolic protection device) and with implantation of a carotid stent Protégé. Blood flow in the right internal carotid artery has been restored, there are no carotid artery stenoses on the right, the basin of the middle cerebral artery on the right is completely contrasted. In two days, there is normalization on the CT perfusion maps and recovery of the patient's cognitive functions to the MoCA 24.

Keywords

• carotid artery traumatic dissection occlusion; mine-blast trauma; explosive shock wave; endovascular treatment.