Skip to main content
SpringerLink
Log in

Intraoperative decision-making in thrombectomy for bilateral cerebral embolism: a mimic of thrombus migration

  • Neuro-Images
  • Published:
Acta Neurologica Belgica Aims and scope Submit manuscript

Abstract

This study thoroughly examines the challenges in managing bilateral embolization, emphasizing intraoperative judgment. It aims to underscore the necessity of accurate etiological judgments and the limitations of cross-circulation thrombectomy. A 59-year-old male with hypertension and atrial fibrillation developed sudden limb twitching, progressing to limb paralysis and speech impairment. Neurological assessments identified multiple symptoms, while a head CT scan excluded intracranial hemorrhage. A mechanical thrombectomy revealed occlusions in the right internal cerebral artery (ICA) and left middle cerebral artery (MCA). Thrombus migration from the ICA terminus was misinterpreted as an escape from the anterior communicating artery, leading to unsuccessful thrombus retrieval. This study highlights the infrequency of bilateral embolic infarctions and intraoperative misjudgments arising from thrombus migration during thrombectomy. It underscores the limitations of cross-circulation thrombectomy and emphasizes a comprehensive risk–benefit analysis. The insights provided deepen the comprehension of thrombus migration patterns and inform strategies for bilateral embolism, focusing on optimal revascularization techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Li Z, Wu S, Zhao S, Li N, Ma W, Jiang G et al (2023) Successful mechanical thrombectomy in acute bilateral M1 middle cerebral artery occlusion: a case report and literature review. BMC Neurol 23(1):119

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Li D, Chen Z, Fan T, Zhao X, Qi H, Liang X et al (2021) Cross-circulation thrombectomy through posterior communicating artery for acute middle cerebral artery occlusion using Solitaire FR stent with intermediate catheter assisting technique. Neurol Neurochir Pol 55(4):403–406

    Article  PubMed  Google Scholar 

  3. Amuluru K, Romero CE, Pyle L, El-Ghanem M, Al-Mufti F (2018) Mechanical thrombectomy of acute middle cerebral artery occlusion using trans-anterior communicating artery approach. World Neurosurg 112:46–52

    Article  PubMed  Google Scholar 

  4. Sultan-Qurraie A, Rozansky G, Cox JA, Lazzaro M (2017) Cross-circulation thrombectomy with use of a stent retriever: a case report. Interv Neuroradiol 23(4):422–426

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nappini S, Limbucci N, Leone G, Laiso A, Wlderk A, Mangiafico S (2017) Trans-anterior communicating artery primary stenting in acute tandem middle cerebral artery-internal carotid artery occlusion due to thoracic aortic stent graft. World Neurosurg 106(1050):e21–e24

    Google Scholar 

  6. Kim SK, Baek BH, Heo TW, Yoon W (2016) Successful cross-circulation stent-retriever embolectomy through posterior communicating artery for acute MCA occlusion by using Trevo XP ProVue. Neurointervention 11(1):55–58

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Padalino DJ, Deshaies EM (2012) Tandem middle cerebral artery-internal carotid artery occlusions: reduced occlusion-to-revascularization time using a trans-anterior communicating artery approach with a penumbra device. J Neurosurg 116(3):665–671

    Article  PubMed  Google Scholar 

  8. Liu W, Kung DK, Mahaney KB, Rossen JD, Jabbour PM, Hasan DM (2012) Anterior-to-posterior circulation approach for mechanical thrombectomy of an acutely occluded basilar artery using the penumbra aspiration system. World Neurosur. 77(2):398.e17-398.e20

    Article  Google Scholar 

  9. Hui FK, Narayanan S, Cawley CM (2010) Posterior-to-anterior circulation access using the Penumbra Stroke System for mechanical thrombectomy of a right middle cerebral artery thrombus. World Neurosurg 73(1):17–21

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Disclosure

The authors report no disclosures relevant to the manuscript.

Funding

None.

Author information

Author notes

  1. Debo Li and Jian Wang have contributed equally to this work and share first authorship

Authors and Affiliations

  1. Department of Neurology, West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China

    Debo Li, Jian Wang, Lei Chen & Fayun Hu

  2. Department of Neurology, The First People’s Hospital of Shuangliu District, Chengdu, 610299, Sichuan, China

    Debo Li

Authors
  1. Debo Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fayun Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Lei Chen or Fayun Hu.

Ethics declarations

Conflict of interest

None declared.

Ethics approval

This report was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University.

Informed consent

Informed consent was obtained from the patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, D., Wang, J., Chen, L. et al. Intraoperative decision-making in thrombectomy for bilateral cerebral embolism: a mimic of thrombus migration. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-023-02433-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13760-023-02433-5

Keywords

Search

Navigation