Stent retriever for iatrogenic cerebral thromboembolism treatment

Thromboembolism is one of the dangerous complications of cerebrovascular endovascular surgeries, often resulting in severe disabilities. A clinical case of using stent retriever for treating iatrogenic cerebral thromboembolism occurred as a complication of diagnostic cerebral angiography is presented. Patient M., 49 years, was admitted in the department of neurology with referral diagnosis of subarachnoid hematoma. No pathologic changes of intracranial arteries were revealed on multi-spiral computed tomography, so cerebral angiography was administered. After administration of heparin (100 U/kg), selective cerebral angiography of all the intracranial vascular beds was performed using a diagnostic cerebral catheter with some technical difficulties. After the intervention was finished, the patient developed non-focal neurological symptoms, left-sided hemianopsia. Angiography of posterior circulation system was repeated immediately, left posterior cerebral artery occlusion was found. Stent retriever was used to restore the intracranial blood flow. An intracranial stent retriever Solitaire (EV3) was delivered to the occlusion and deployed with exposition of 5 minutes and further removal. Control angiography showed complete restoration of the intracranial blood flow without signs of distal embolism. The neurologic deficit had completely resolved during first 24 hours after the surgery. The presented clinical case illustrates the effect of stent retriever use to to restore the intracranial blood flow and stresses the need for such devices availability in departments performing cerebral surgeries in patients with cerebrovascular diseases.

cerebral angiography, endovascular recanalization