068 - Rare Ischemic Fibrocartilaginous Embolic Stroke to the Basilar Artery
Thomas Madaelil, Dr. – Physician, TCSI
Purpose: Reported cases of fibrocartilaginous embolization (FCE) are rare in literature. This case would be the first successful aspiration thrombectomy performed with complete resolution of presented neurologic symptoms. A 51-year-old African-American woman presented with extensive neurologic deficits due to a cerebral embolism of fibrocartilaginous origin, likely dissected from a C5/C6 uncovertebral osteophyte. This case provides some insight on an unusual cerebrovascular stroke pathology.
Material and Methods: A 6 fr Cerebase sheath was advanced into the left VA proximal to the C5/C6 level. An AXS Catalyst 6 132cm intermediate catheter was advanced over a Phenom 21 microcatheter and Synchro 2 soft guide wire through the Cerebase into the left VA and advanced to the proximal BA under continuous aspiration. After the microcatheter and guide wire were removed, a 60cc locking syringe was connected to the Catalyst 6 and aspiration thrombectomy was performed.
Results: Patient is right-handed and presented with acute shoulder pain, dysarthria, nystagmus, dysmetria and diplopia. CTA of head and neck revealed occlusion at the C5/C6 level in the dominant left vertebral artery. A lateral disc osteophyte was observed. A partial filling defect in the left mid-Basilar artery and occlusion of distal BA extending into the left P1 segment was also noted. An emergency aspiration thrombectomy was performed to retrieve the embolus and relieve the symptoms. Follow up angiography revealed partial improvement in the opacification of the BA. Two additional aspiration thrombectomy passes led to continuous improvement in the BA with ultimate reperfusion of the basilar artery. Remarkably, the patient’s symptoms had completely resolved. A NIHSS score of 0 was given. The patient was released and follow up for future stroke complications was evaluated.
Conclusions: Only one reported case of FCE was found in literature. Where a 17-year-old girl died due to ischemic stroke complications. Neuropathological exam revealed extensive right MCA ischemic infarction, edema, and herniation of the cortical matter. Autopsy revealed FCE in the coronary and cerebral vessels indicating a central source of embolism. However, in our case, we postulate a posterior lateral disk extrusion into the left VA as well as complete patient recovery. The pathogenesis and nature of fibrocartilage emboli formation is poorly understood. We think our case provides greater insight into this phenomenon.