Clinical cases of perforation of the wall of the middle cerebral artery during thrombextraction in patients with acute ischemic stroke

Introduction. Endovascular thrombextraction is the treatment of choice for ischemic stroke associated with thrombosis of large cerebral arteries. According to the literature, complications due to thrombextraction occur in 4–29 % of cases. Distal thrombus migration, arterial dissection, and hematomas at the femoral artery puncture site are the most common complications of the procedure. One rare but serious complication is cerebral artery perforation during thrombextraction, the incidence of which varies from 0.3 to 9 % according to different researchers.

Description of cases. This paper describes two clinical cases of patients with ischemic stroke in whom perforation of the middle cerebral artery occurred during thrombextraction. To stop bleeding in both cases, embolization and closure of the middle cerebral artery lumen with microcoils were performed. Both patients survived despite developing ischemic areas. One patient was discharged with a functional outcome according to the modified Rankin scale of Rankin 2, the second patient – Rankin 4.

Discussion and conclusion. In our series, the incidence of cerebral artery perforation during thrombextraction was 0.5 % (2 out of 403 cases). Both cases involved elderly women (72 and 77 years old). No risk factors or causes for middle cerebral artery perforation were identifi ed. A review of the surviving angiograms and surgical protocols revealed no technical errors or difficulties during the procedure. Despite the catastrophic complication, prompt embolization of the vessel and subsequent intensive care (control of cerebral edema and vasospasm) saved the patients’ lives and even achieved satisfactory functional status in one case.

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