Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5668
Peer-review started: March 5, 2021
First decision: April 29, 2021
Revised: May 7, 2021
Accepted: May 15, 2021
Article in press: May 15, 2021
Published online: July 16, 2021
Processing time: 124 Days and 0.2 Hours
Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions, and even distal, medium vessel occlusions. A distal, medium vessel has a tortuous course and thinner wall compared to large arteries, making it more susceptible to damage. Here, we review the treatment strategies for arterial perforation during mechanical thrombectomy, and we report the case of a patient treated with gelfoam embolization.
A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia. The initial National Institutes of Health Stroke Scale score was 15. Computed tomography (CT) and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion. During endovascular mechanical thrombectomy, arterial rupture occurred. The patient’s vital signs were stable, but delayed angiography showed persistent active bleeding. Therefore, selective embolization of the injured artery was performed using gelfoam. Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis. A localized subarachnoid hemorrhage (SAH) was confirmed on a follow-up CT scan. A repeated CT scan after 12 d showed resolution of the SAH, and rebleeding did not occur.
Rescue embolization with gelfoam could be considered an additional option in distal, medium vessel perforation.
Core Tip: Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions, and even for distal, medium vessel occlusions (DMVOs). Perforation tends to occur particularly with DMVOs, increases mortality, and lowers the rate of good functional outcomes. The optimal rescue technique for vessel perforation during mechanical thrombectomy has not been established. This case report reviews the treatment strategy of rescue embolization for arterial perforation and presents the case of a patient treated with gelfoam embolization.