Embolic complications resulting from significant innominate artery stenosis (IAS) is a rare pathology. We present a clinical case of IAS with subsequent middle cerebral artery (MCA) occlusion detected with cerebral computed tomography and neurovascular ultrasound and successfully treated using endovascular embolectomy within 4 hours after symptom onset. The patient recovered well. Additional IAS endarterectomy days later showed fresh thrombi on the vessel wall, and resulted in complete normalisation of cerebral blood flow.
This is to the best of our knowledge the first case of MCA embolectomy from an emboligenic IAS. Although not used in the successful embolectomy trials in the last years, neurosonography was crucial to guide the revascularisation therapy and the hemodynamic compromise in IAS might have led to ischemic preconditioning and thus better outcome upon revascularisation. Endovascular embolectomy in patients with IAS and MCA occlusion must not necessarily need stent angioplasty of the IAS in the acute stroke phase thus avoiding double platelet therapy upon cerebral reperfusion.
Given the rareness of the disease, an international registry of similar cases may help to better understand the disease and guide acute interventions.
Saulius Taroza, Jurgita Valaikiene, Felix Schlachetzki and Aurimas Knokneris