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AJNR - American Journal of Neuroradiology

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Microsnare-Assisted Mechanical Removal of Intraprocedural Distal Middle Cerebral Arterial Thromboembolism

Pieter Fourie^a and Ian C. Duncan^a

^a From the Unitas Interventional Unit, Unitas Hospital, Lyttleton, South Africa

View larger version (105K): [in a new window]   FIG 1. Selective left internal carotid digital subtraction arteriogram shows the communicating segment aneurysm.

View larger version (100K): [in a new window]   FIG 2. Check arteriogram during coil placement shows proximal occlusion of one of the middle cerebral artery post-trifurcation trunks with absence of filling of vessels in the paracentral and parietal region. The arrow indicates the level at which the trunk is occluded before intra-arterial abciximab infusion.

View larger version (71K): [in a new window]   FIG 3. After abciximab bolus administration via direct microcatheter infusion, flow has been reestablished within the occluded trunk, leaving a small fragment of resistant material within a distal branch (arrow).

View larger version (134K): [in a new window]   FIG 4. Microsnare tip is seen protruding from the Excel microcatheter at the level of the fragment.

View larger version (121K): [in a new window]   FIG 5. Check arteriogram obtained after removal of the microsnare and microcatheter shows that the fragment has been removed and normal flow has been reestablished in the previously occluded branch (arrow).