Acute Treatment of Ischemic Stroke Caused by Stent Graft Thrombosis After Thoracic Endovascular Aortic Repair

TL;DR

A 52-year-old man with a history of aortic dissection experienced a stroke due to stent graft thrombosis and was successfully treated with mechanical thrombectomy and surgical interventions.

Contribution

This case highlights an alternative treatment approach for stroke caused by stent graft thrombosis in complex anatomical scenarios.

Findings

Mechanical thrombectomy via direct carotid artery puncture successfully recanalized the occluded arteries.

The patient returned to work after two years of follow-up without stroke recurrence.

Interdisciplinary collaboration improved outcomes in this complex cerebrovascular case.

Abstract

Planning for the acute phase of ischemic stroke in postoperative patients with aortic dissection is difficult from the perspective of concerns about worsening disease related to aortic dissection due to intravenous thrombolytic agents and securing access routes when mechanical thrombectomy is planned. Herein, we report that a 52-year-old man underwent thoracic endovascular aortic repair for acute type B aortic dissection. One year after the procedure, the patient developed a stroke caused by stent graft thrombosis, and computed tomography angiography showed occlusion of the left common carotid artery and left internal carotid artery. Stroke neurologists performed mechanical thrombectomy via a direct approach from the left common carotid artery, and successful recanalization was achieved. Furthermore, ligation of the proximal portion of the left common carotid artery and bypass surgery on the distal portion of the left common carotid artery were performed by cardiovascular surgeons. Although the patient had a postoperative hemorrhagic infarction, he returned to work without a recurrence of stroke after two years of follow-up. A direct carotid artery puncture we performed is an alternative in cases of anatomical difficulty or an unfavorable aortic arch. This case highlights not only the significance of interdisciplinary collaboration between cardiac and neurological specialists but also the impact of training dual-specialty cerebrovascular neurosurgeons on patient outcomes.

Figures