Internal and middle cartoid artery rethrombosis post clot retrieval

Case contributed by Dr Craig Hacking

Presentation

Follow up CT 2 hours post right terminal ICA, M1 and A1 clot retrieval which was performed 4.5 hours after symptom onset. Initial external CT not available.

Patient Data

Age: 69
Gender: Male

There is cytotoxic oedema of the right cerebral hemisphere with loss of grey-white matter differentiation and mild effacement of the right lateral ventricle, in keeping with acute MCA and ACA ischaemia, with sparing of the right PCA territory. The left ACA territory also shows loss of grey-white matter differentiation. No midline shift or uncal herniation. No hydrocephalus.

The right MCA and distal ICA is hyperdense suggesting re-thrombosis.

Hyperdensity within the medial right temporal lobe posterior to the hyperdense MCA.

Conclusion

Acute ischaemia in the right cerebral hemisphere involving the right MCA and ACA and left ACA territories. Hyperdense right MCA suggesting re-thrombosis.

Small hyperdensity in the medial right temporal lobe which may represent a focus of haemorrhagic transformation or contrast staining from the prior angiogram.

Case Discussion

Re-thrombosis is a complication of clot retrival.

The patient died 2 days later.

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Case information

rID: 40147
Case created: 9th Oct 2015
Last edited: 12th Jun 2016
Inclusion in quiz mode: Included

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