Mechanical Thrombectomy for Distal Occlusion of the Anterior Cerebral Artery

The benefit of mechanical thrombectomy (MT) for distal occlusions remains controversial. Current evidence suggests that patients with a high NIHSS score and/or severe disabling neurological deficit may benefit from MT. We describe a case of MT for distal occlusion of the anterior cerebral artery (ACA) in a 69-year-old man. On awakening, the patient presented with severe right lower limb paresis that was expected to be highly disabling if persistent. Initial brain imaging showed an ACA occlusion at the A2-A3 segmental junction and a clear mismatch with no correlate on fluid attenuation inversion recovery (FLAIR) imaging in the ACA territory. We opted for combined therapy with intravenous thrombolysis and aspiration thrombectomy. After three unsuccessful attempts with contact aspiration, we switched to a stent retriever technique (Solitaire FR 3/20), which allowed complete reperfusion and excellent clinical outcome. Indications, techniques, and complication risks of MT for distal occlusions are described in this chapter.