Recanalization of an ACM-CTO after 2 years of occlusion

Find out how Dr Zhang Xiaoxi performs MCA-CTO recanalization after two years of occlusion on a 46 year old patient.

Case presentation

A 46-year-old male patient
Presentation: sudden aphasia and weakness of the left limb
Medical history: on 13 September 2020, the patient suffered sudden aphasia and left limb weakness for 10 minutes, without any significant inducing factor. The symptoms subsequently resolved and no similar symptoms occurred. CTA showed an MCA stenosis at the local hospital. But the patient ignored the physician’s advice.
Diabetes was diagnosed for 5 years.

Risk factors

CT angiography, 2020-9-13, local hospital

Follow-up, 2021-10-12

R-MCA occlusion

DSA, 2022-07

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R-MCA occlusion, with satisfactory vessel bed distal to the occlusion

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The shortest length of occlusion was 2.0 mm

High-resolution MRI, 2022-08-17

No enhanced vessel wall signal

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Endovascular treatment

The true lumen was easily found

Balloon dilation was performed

CT showed no hemorrhagic transformation

NIHSS = 0, no focal infarction observed

Conclusion

Careful selection of the chronic total occlusion (CTO) using high-resolution CTA and MRI facilitates the endovascular treatment procedure.
Even when occluded for more than a year, MCA could also be recanalized without complication.
A short occlusion length, a satisfactory vessel bed distal to the occlusion site and the absence of vessel wall enhancement are the keys to recanalization.
High-resolution MRI showed a stable occlusion with no evidence of inflammation, bleeding or calcification.