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Described is the case of a 22 − year − old man who was admitted to hospital in an unconsciousness state and manifested bulbar palsy and abn 〔 ｝rmal ocular movements as a result of severe head and neck injuries that he had sustained 5 months earlier ． Magnetic resonance illlaging ( MRI )revealed a polltille infarction and cerebral angiography demonstrated occlusions of the left common carotid artery ， the left vertebral artery and the basilar artery ． This case exemplifies the possibility that delayed intracranial arterial occlusi 〔 ms can occur even several months after a head and neck illjury ． (

Objective We report a case of mechanical thrombectomy (MT) via the distal transradial approach (dTRA) and technical tips. Case Presentation An 89-year-old woman was transferred to our hospital due to back pain after a fall and sudden-onset left hemiparesis. We performed MT because three-dimensional computed tomography angiography (3D-CTA) revealed right middle cerebral artery (MCA) occlusion. The access route was Type 3 aortic arch. The abdominal aorta and common iliac artery were tortuous and partially dissected, and she had a lumbar vertebra fracture. We selected dTRA in consideration of safety, ease of access, and less postoperative postural restriction. The first pass resulted in complete recanalization using an aspiration catheter and stent retriever. Her symptoms rapidly improved and she was discharged with a modified Rankin Scale score of 1. Conclusion dTRA in MT may be a treatment option.

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