Introduction Dissection of the middle cerebral artery(MCA) is a rare etiology of ischemic stroke in adult population. We report a case of endovascular treatment in patient with acute complete occlusion of MCA due to dissection.

Case Description A 69-year-old male patient developed right-sided hemiparesis and aphasia. Brain perfusion computed tomography revealed ischemic penumbra in the left MCA territory. Cerebral angiography showed complete occlusion of the left MCA and there is a stasis of contrast at distal MCA. He underwent mechanical thrombectomy and retrieved stent had captured a small red thormbus. Although there is a focal contrast defect of MCA that suggest an intimal flap of dissected vessel wall, the patient made a complete recovery and angiography showed full recanalization of MCA. Ten hours after the patient was transferred to intensive care unit, his motor worsened to grade 2 in the rigth extremities and aphasia appeared. Cerebral angiography showed complete occlusion of MCA. Urgent stent angioplasty was done to stabilize the dissected flap and maintain the patency of MCA. Final angiography showed restored flow of the MCA and resolution of the dissection. The patient completely recovered his motor and speech deficit.

Results The present case suggests several angiographic findings indicating the possibility of dissection of occluded MCA. If patency of MCA is not restored effectively after mechanical thrombectomy, stent angioplasty may be effective to maintain the flow of MCA in case of the MCA dissection.

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Abstract P065 Figure 1

Disclosure of Interest no.