Roentengen-endovascular method of cerebral blood flow restoration in acute tandem occlusion of the internal carotid artery with embolism development in the middle cerebral artery

Aim. This article proposes a roentgen-endosurgical method of performing intracranial arteries revascularization in acute tandem occlusion of the internal carotid artery with the distal embolism development in the middle cerebral artery.

Methods. In the period from 2007 to 2014 endovascular revascularization in the internal carotid artery acute thrombosis was performed in 18 patients. Tandem occlusion of the cervical, petrous, cavernous and terminal segments of the internal carotid artery (53.3%) was the most commonly diagnosed. Isolated occlusion of the internal carotid artery cervical segment was determined in 5 (33.3%) patients, of the terminal segment - in 3 (20%) cases. L- and T-types occlusion of the internal carotid artery terminal segment thrombosis frequency were comparable and amounted to 20%. In 5 patients the internal carotid artery tandem occlusion with the distal embolism development in the middle cerebral artery occurred. In this type of injury a method for blood flow restoration in middle cerebral artery without restoring antegrade blood flow in the internal carotid artery was developed and applied.

Results. Full blood flow restoration in the middle cerebral artery using this method was achieved in these patients in all cases. Complications associated with the intervention were not registered.

Conclusion. The proposed method can be used in patients with the internal carotid artery acute tandem occlusion and the distal embolism development in the middle cerebral artery; the use of this type of revascularization is possible in patients with well-developed communicating arteries that can provide an adequate perfusion volume in the middle cerebral artery.