Objective: While intracranial mechanical thrombectomy has been established as a treatment, atherothrombotic brain infarction due to stenosis of major cerebral arteries is occasionally difficult to treat as severe stenosis persists after recanalization, eventually requiring percutaneous transluminal angioplasty (PTA) or stent placement. The contents and results of mechanical thrombectomy for atherothrombotic brain infarction that we have encountered are presented. Methods:The subjects were 17 patients diagnosed with atherothrombotic brain infarction among the 99 patients with cerebral infarction accompanied by major intracranial artery occlusion treated at our hospital during the 30 months from January 2014 and June 2016. Recanalization graded as Thrombolysis in Cerebral Infarction (TICI) 2b or higher was regarded as effective, and the outcome was evaluated using the modified Rankin Scale (mRS). Results:The responsible lesion was located at the origin of the internal carotid artery (ICA) in three patients, in the ICA siphon in four patients, middle cerebral artery (MCA) in five patients, vertebral artery (VA) in two patients, and basilar artery (BA) in three patients. Effective recanalization was achieved in 82.4%, the mRS score was 0-2 in 52.9%, and the postoperative mRS score was the same as before treatment in 11.8%. Conclusion:The outcome of intracranial mechanical thrombectomy for atherothrombotic brain infarction accompanied by major intracranial artery stenosis was favorable in many patients, and aggressive treatment is considered recommendable. In addition, safe and appropriate execution of additional treatments for residual stenotic lesions leads to favorable outcomes.

Distal filter protection should be combined with proximal protection for the lesions with antegrade flow to prevent distal migration of the carotid debris.

A case of cerebral infarction from carotid artery thrombosis in a background of anemia

Objective: The impact of advanced age on the safety and efficacy of carotid artery stenting (CAS) is controversial. The aim of this study was to retrospectively evaluate the safety of CAS in the elderly. Methods: In total, 111 patients (119 procedures) from October 2008 to November 2011 were included; of these, 28 patients (31 procedures) aged <70 years, 49 patients (52 procedures) were septuagenarians, and 34 patients (36 procedures) were octogenarians. The primary outcome event for the analysis was any stroke within 30 days after CAS. The secondary outcome event was new diffusion-weighted imaging (DWI) lesions on the day following stenting. Results: The incidence of stroke was 3.4% (4 of 119 procedures; two in the <70 years of age, one in the septuagenarians, and one in the octogenarians). The incidence of new DWI lesions immediately after CAS was 17% and was highest in the group aged ≥80 years. Conclusion: Advanced age alone does not exclude adequate CAS, but care must be taken regarding plaque vulnerability at the target site and atherosclerotic change of the access route.• Key words • carotid artery stenting, carotid artery stenosis, age Correspondence Address: Jun MORIOKA,