Successful recanalization of an acute occlusion of the left internal carotid artery and the left cerebral middle artery via the transbrachial approach: A case report

This case study presents an elderly patient with an acute ischemic stroke due to occlusion of the left internal carotid artery (ICA) and the left cerebral middle artery (MCA). The study aimed to evaluate the feasibility and effectiveness of a transbrachial approach for mechanical thrombectomy (MT) in patients with tandem occlusions. The patient presented with stroke symptoms, including severe aphasia, right-sided facial palsy, left gaze deviation and right-sided weakness. The patient had a history of uncontrolled hypertension. Diagnostic tests, including computed tomography and angiography, confirmed the presence of occlusions in both the left ICA and the left MCA. The patient received MT bridging intravenous thrombolysis. When bilateral iliac arteries were found to be occluded, a puncture via the transbrachial approach was attempted. Angiography suggested an acute occlusion of both the left ICA and the left MCA. The C1 segment was inflated with a pre-dilated balloon and the thrombus in the M1 segment was removed successfully. Successful reperfusion was achieved, and the patient had a good outcome at discharge. No access-site complications were encountered. Transbrachial approach for MT, especially in those with tandem occlusions, is feasible and could provide an alternative to the transfemoral approach. This approach may be beneficial for patients with occlusions in multiple sites or with iliac artery occlusions. Further research is needed to evaluate the long-term effectiveness of this approach.