Acute Left M1 Stroke With Critical Left Internal Carotid Artery Stenosis: Video Case

Abstract

We present the case of a 68-yr-old woman who presented with an acute left middle cerebral artery syndrome. Noninvasive angiography obtained 13 h after last known well time demonstrated both left M1-segment middle cerebral artery (MCA) occlusion and near-complete occlusion of the left internal carotid artery (ICA) just distal to the carotid bifurcation. Intervention was offered given the sizeable mismatch demonstrated by computed tomography (CT) perfusion imaging. After administering loading doses of aspirin and clopidogrel, we initially performed carotid angioplasty and stenting to open the internal carotid artery, which was otherwise impassible. Subsequently, thrombectomy of the M1 occlusion was performed with direct aspiration. Postprocedural imaging demonstrated preservation of the at-risk brain parenchyma. The patient demonstrated significant improvement in strength and speech after the procedure, and she was discharged to an inpatient rehabilitation center for further treatment. The patient and her family gave consent for this report.