Abstract
In acute ischemic stroke, various endovascular approaches have been reported with
high recanalization rates and good clinical outcomes. However, the best device or
technique for the first attempt at mechanical thrombectomy remains a matter of debate.
We report a case in which endoluminal injury from initial stent clot retrieval possibly
caused repeated middle cerebral artery occlusion. A 74-year-old man presented with
left-sided hemiplegia and was diagnosed with a right internal carotid artery occlusion.
He underwent endovascular thrombectomy using a stent clot retriever. Although complete
recanalization was achieved in the first pass, repeated middle cerebral artery occlusion
occurred. Angiography revealed an irregular inner surface and thrombus formation in
the superior branch of the second segment of the right middle cerebral artery. There
is a risk of endoluminal injury due to stent retrieval, especially using a large sized
stent against small branches. Antiplatelet therapy may be effective for preventing
recurrent occlusion.
Key Messages We report a case in which endoluminal injury from initial stent clot retrieval possibly
caused repeated middle cerebral artery occlusion. There is a risk of endoluminal injury
due to stent retrieval, especially using a large sized stent against nonvisible small
branches.
Keywords
acute ischemic stroke - mechanical thrombectomy - recurrent occlusion - stent clot
retriever
