Delayed reperfusion therapy for ischemic stroke tandem occlusion with subsequent secondary prophylaxis of cerebral ischemic events: A case report and literature review.

Mechanical thrombectomy is currently the gold standard treatment of large vessel occlusions, especially in anterior circulation acute ischemic stroke. At the same time, the problem of tandem occlusions seems especially important since most of the major clinical mechanical thrombectomy studies did not specifically evaluate patients with concomitant extracranial occlusions or critical stenoses. To date, there is no universally accepted optimal treatment strategy for such tandem lesions in acute ischemic stroke: it remains unclear which lesion - intracranial or extracranial - should be treated first. The selected reperfusion method should be based on the patients' individual characteristics, data from non-invasive radiologic studies, and the stroke team experience. We present a case of successful reperfusion therapy of acute tandem occlusion of the right internal carotid artery, followed by contralateral carotid artery stenting in a patient with stenosing extracranial atherosclerosis.

Clinical case of successful treatment of internal carotid artery dissection during aneurysm embolization in acute period of subarachnoid hemorrhage.

Artery dissection during embolization of an intracranial aneurysm is not a frequent complication. In most cases, the tactics of treatment are limited to the appointment of anticoagulants or balloon angioplasty. We present a clinical case of successful treatment of a woman of 47 years. Dissection of the internal carotid artery occurred during aneurysm embolization in the acute period of subarachnoid hemorrhage and required coronary stent implantation. The absence in the long-term period of signs of restenosis or mechanical damage to the coronary stent in the installed position indicates the possibility of implanting it in the indicated position in urgent situations. The clinical significance of the described case consists in combining sequentially rarely occurring events one after another.

Transseptal occluder migration after transcatheter atrial septal aneurysm and double secondary septal defect correction: A case report.

We present a case of secondary atrial septal defect transcatheter correction attempt in a 72 years old male, complicated by the device migration. The occluder was captured, pulled down to the common femoral artery and retrieved through the arteriotomy site. Second attempt was successfully performed using combination of transesophageal echo (TEE) and sizing balloon to accurately measure the defect diameter. This case underscores the importance of TEE ultrasound, sizing balloon, and contrast fluoroscopy combination to achieve accurate device sizing. Our calculation approach significantly increased the success rate of the septal defect closure procedure and potentially reduced the risk of immediate and mid-term complications. Combination of measuring methods should be used in order to accurately assess the device diameter.

Simultaneous internal carotid artery stenosis and ipsilateral anterior communicating artery saccular aneurysm treatment: a case report.

The presence of ipsilateral aneurysm in the stenosis of the internal carotid artery is determined by computed tomography angiography in 1.8%-3.2% of cases. The literature describes the most varied options for treating this pathology: isolated or alternate, and now the method of simultaneous endovascular treatment - carotid stenting and endovascular embolization of aneurysm - is gaining popularity. We presented a clinical case of treatment of 61 women with critical stenosis (90%) and tortuosity of the internal carotid artery in combination with ipsilateral saccular aneurysm of the anterior connecting artery. The uniqueness of this case lies in the fact that a hybrid approach has been applied in the treatment of pathology, not previously described in the literature. The case is highlighting the potential complexity of concomitant vascular cervical and cerebral pathology and the necessity of surgical and endovascular team interactions to choose the appropriate methods of treatment.

Endovascular management of the peripherally inserted central venous catheter iatrogenic pinch-off syndrome: A case report.

The recent increase in the number of patients with implanted peripherally inserted central catheters (PICCs) requires physicians to be familiar with rare and unusual complication-pinch-off syndrome (POS). We present a case of a 40-years-old female with human epidermal growth factor receptor type 2 (HER2)-positive breast cancer and implanted Groshong PICC (BARD). The patient was admitted for an elective chest and abdomen CT angiography control after finishing her trastuzumab and paclitaxel chemotherapy course a month earlier. Immediately after the contrast media power injection, the PICC line was embolized to the right segmental pulmonary artery. Due to the low complications rate and early patient ambulation percutaneous foreign body retrieval is a primary option for the pinch-off syndrome, especially in frail, and vulnerable cancer patients. This case underscores the feasibility and safety of percutaneous venous interventions in patients with embolized venous infusion devices.

Successful retrograde recanalization of acute right dominant vertebral artery occlusion through the left posterior communicating artery in a patient with acute vertebrobasilar ischemic stroke.

Advanced endovascular technology and techniques allow interventional radiologists to utilize novel ways of basilar artery recanalization in the setting of acute ischemic stroke, especially when routine approaches are not eligible. Several authors described nonstandard revascularization techniques in acute ischemic strokes due to basilar and middle cerebral arteries occlusions with full technical and clinical success. In this report, we present retrograde right vertebral artery recanalization using left posterior communicating artery for subsequent anterograde balloon angioplasty and stenting of a right vertebral artery ostium followed by full vertebrobasilar blood flow restoration. The case underscores the complexity of arterial thrombotic events, the beneficial role of endovascular intervention in vertebral occlusions and the necessity of prospective studies that identify optimal methods of treating vertebrobasilar stroke due to large vessel occlusions and their effectiveness and safety.

Successful carotid thrombus aspiration, middle cerebral mechanical thrombectomy, and axillary artery clot disruption attempt in a patient with acute ischemic stroke and critical upper limb ischemia.

Acute thrombotic occlusions of the large vessels, such as internal carotid artery, arms and legs arteries, and intracranial vessels, frequently require multiple techniques such as selective thrombolysis, manual aspiration, and stent retrievers for mechanical thrombectomy with combination of the mentioned techniques. Because of the massive thrombotic burden associated with these conditions, the response to systemic intravenous thrombolysis is poor. We present a case of a successful massive thrombi aspiration in a single attempt using an 8Fr guide catheter with aspiration syringe, subsequent ipsilateral middle cerebral artery mechanical thrombectomy, and axillary artery clot disruption attempt in a patient with acute ischemic stroke, right arm critical ischemia, and persistent atrial fibrillation.