Case report: thrombectomy for left internal carotid artery occlusion with ipsilateral dual accessory middle cerebral arteries

Abstract

Accessory middle cerebral arteries (AMCAs) are found in 0.3-4.0% of cases, and ipsilateral dual AMCAs are rare. A seventy-three-year-old man presented with right hemiplegia and total aphasia. Magnetic resonance angiography showed left carotid artery occlusion. We infused him with tissue plasminogen activator. Digital subtraction angiogram showed revascularization of the left internal carotid artery. However, the left proximal anterior cerebral artery was occluded. We performed mechanical thrombectomy and achieved partial reperfusion. CT angiography on the tenth day showed ipsilateral dual AMCAs. Due to middle cerebral artery anomalies, we performed mechanical thrombectomy using contact aspiration which is safer than other techniques.

Keywords: Accessory MCA; Anomaly MCA; Contact aspiration; Mechanical thrombectomy; Triplicated MCA.