Diagnostic Images: Total occlusion of left cervical ICA

Sathya Narayanan R

Consultant Interventional Radiologist, Kauvery Hospital, Chennai

Case Presentation

A 49-year-old male had an in-hospital stroke

  • MRI brain – few patchy acute infarcts in left parietal lobe.
  • CT-angiogram – occlusion of M2 superior division of left MCA.

Critical stenosis of an osteo-proximal segment of left ICA secondary to an ulcerated plaque.

The thrombus in the superior division of MCA is likely secondary to ruptured extracranial ICA plaque.

After explaining the risks and benefits, the patient was taken up for mechanical thrombectomy.

The thrombus in MCA was retrieved with a stent retriever resulting in TICI 3 recanalization. The left ICA stenosis was stented with a self-expanding metal stent to prevent further strokes.

Post Procedure Outcomes

  • The patient’s power has improved from 0 to 4 the next day.
  • CT- brain shows no bleed. Therefore, he was extubated.

Fig (A): CT angiogram – Critical stenosis or near total occlusion of osteo-proximal segment of left ICA

Fig (B): DSA left ICA – Abrupt cut off superior segment of left middle cerebral artery (MCA)

Fig (C): DSA left ICA – TICI 3 recanalization of superior division of left MCA

Fig (D): DSA left CCA – Ulcerated plaque causing severe stenosis of osteo-proximal segment of left ICA

Fig (E): DSA left CCA – Good resolution of stenosis in osteo proximal segment of ICA following stent placement.

 

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