Transcatheter snare removal of acute middle cerebral artery thromboembolism: Technical case report

OBJECTIVE AND IMPORTANCE: We describe the case of a patient in whom a snare designed for the removal of foreign bodies was successfully used to retrie ve a thromboembolism from the middle cerebral artery. This technique can be used to reestablish blood flow when maximal pharmacological therapies have failed. CLINICAL PRESENTATION: A 38-year-old man with scrotal squamous cell carcino ma presented with the abrupt onset of left hemiparesis and numbness. Comput ed tomography of the head showed no hemorrhage or hypodensity, and right mi ddle cerebral artery thrombosis was suspected. INTERVENTION: Cerebral angiography demonstrated a near-total occlusion of t he right middle cerebral artery at the M1-M2 junction. The administration o f intra-arterial urokinase, systemic heparin, and systemic abciximab, and m echanical maceration failed to lyse the clot. A 4-mm goose-neck snare was g uided through a microcatheter, and the clot was snared and withdrawn. Immed iate postoperative angiography demonstrated the reconstitution of normal fl ow, Pathological examination of the snared material was consistent with clo t. By postoperative Day 5, the patient had regained full strength, except f or the fingers of the left hand, which remained moderately weak. Computed t omography demonstrated a right insular and extreme capsular infarct. CONCLUSION: To our knowledge, this is the first reported use of a snare to remove clot in the setting of thromboembolic stroke. As the use of intraart erial thrombolysis increases, transcatheter snare removal of pharmacologica lly resistant clot may be considered as a salvage strategy.