Successful percutaneous transarterial clot removal therapy for embolic occlusion of the internal carotid artery in a patient with left ventricular thrombus: A case report

• Published in: Japanese Journal of Stroke Vol. 27; no. 3; pp. 412 - 418
• Main Authors: Imai, Keisuke, Mori, Takahisa, Izumoto, Hajime, Takabatake, Nozomu, Kunieda, Takenobu, Oofuchi, Hisashi, Miyashita, Yusuke, Shimizu, Hideo
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2005
• Subjects: cardiogenic embolism; clot removal therapy; internal carotid artery occlusion; proximal flow blockade; ventricular thrombus
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.27.412

We report a successful case of percutaneous transarterial clot removal therapy (CRT) for acute embolic internal carotid artery (ICA) occlusion. A 32-year-old woman consuming oral contraceptives and dietary supplement containing ephedrine was admitted to our institution due to left-sided mild hemiparesis. Her magnetic resonance images demonstrated a small infarction of the corona radiata on the right side. An echocardiogram revealed dilated cardiomyopathy complicated by a pedunculated and mobile left ventricular thrombus. The patient received intravenous heparin and oral warfarin immediately after admission, and her symptoms improved rapidly on the 2nd day. However, she suddenly exhibited stupor, motor aphasia, and dense rightsided hemiparesis on the 7th day. Cranial computed tomography (CT) showed neither high density areas nor early CT signs, while emergent cerebral angiography disclosed an occlusion of the left ICA. We assumed that the ICA occlusion was due to recurrent embolism from the left ventricular thrombus and attempted recanalization therapy. After obtaining informed consent from the patient's family, we performed CRT using a basket-type microsnare supported proximal flow blockade with a balloon-guided catheter and additional angioplasty. Immediately after removal of several clots, the left ICA was completely recanalized, although the middle cerebral artery was not recanalized. Her symptoms except for the motor aphasia improved rapidly after the procedure, and her life became completely independent on the 94th day. This case experience suggests that CRT is a potential treatment for patients with acute embolic occlusion of the ICA.