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Posterior cerebral artery (PCA) strokes produce various symptoms. Therefore, the diagnosis is often delayed and patients arrive late for thrombolytic therapy. We report a case of acute isolated PCA occlusion that was successfully treated with endovascular clot aspiration. A 63-year-old man presented with right complete homonymous hemianopia. Diffusion-weighted image (DWI) showed a high-intensity area (HIA) in the occipital lobe, and magnetic resonance angiography (MRA) showed PCA occlusion. Emergency endovascular clot aspiration was performed immediately after the diagnosis. Blood flow in PCA completely recovered 210 min after symptom onset. DWI after surgery showed partial disappearance of HIA, and the patient recovered from the symptom of right complete homonymous hemianopia. Endovascular recanalization is useful for acute PCA occlusion. This is the first reported case of acute isolated PCA occlusion successfully treated with endovascular clot aspiration. Prompt reperfusion results in a good clinical course in patients with PCA stroke. In this case, endovascular clot aspiration resulted in prompt recanalization in a patient with acute isolated PCA occlusion.

Objective: A tip shape of a microguidewire that is safe and highly versatile in coil embolization of cerebral aneurysms was evaluated.Case Presentations: Case 1: A 65-year-old woman with subarachnoid hemorrhage due to rupture of an anterior communicating artery aneurysm which was coil-embolized 7 years before. The aneurysm recanalized and regrew thereafter, and an additional embolization was performed. Angiography before treatment showed 50% stenosis at the origin of the right internal carotid artery (ICA). In addition, the A1 of the right anterior cerebral artery divided from the ICA at a relatively sharp angle. Therefore, the tip of the microguidewire was shaped to a modified pigtail. With this single tip shape, the wire and microcatheter could be safely guided to the anterior communicating artery aneurysm, and satisfactory coil embolization could be achieved. Case 2: A 68-year-old woman with right hemiplegia had a sudden onset of occlusion of the M2 superior trunk of the left middle cerebral artery and underwent thrombectomy. A microguidewire with a tip shaped into a modified pigtail could cross the lesion safely through the occluded segment with no distal view of the course of the vessel. The thrombus was retrieved using a stent retriever, and thrombolysis in cerebral infarction (TICI) 3 could be achieved. Conclusion:This microguidewire tip shaping technique is considered to be safe and effective in various phases of endovascular treatment.

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