Mechanical thrombectomy for cerebral embolism of the posterior inferior cerebellar artery: A case report

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Background: Few studies demonstrated the efficacy of mechanical thrombectomy (MT) for the branches of the posterior circulation, such as the posterior inferior cerebellar artery (PICA). Here, we describe a patient who underwent MT for acute PICA occlusion and achieved a favorable outcome. Case Description: A 68-year-old man presented with dysarthria on waking, followed by movement difficulty. On examination, he had dysarthria, right-sided ataxia, decreased pain sensation on the left side below the neck, and no significant motor paralysis. The National Institutes of Health stroke scale score was 2. The electrocardiogram revealed atrial fibrillation. Diffusion-weighted imaging revealed right lateral medullary infarction. Magnetic resonance angiography revealed obstruction of the right proximal PICA, and fluid-attenuated inversion recovery imaging revealed hyperintensity in the PICA vermian branch of the fourth ventricle, suggesting thrombus. Emergency MT was performed, primarily using aspiration, resulting in partial reestablishment of the blood flow in the occluded vessel. Marked improvement in dysarthria was observed immediately after the procedure. Follow-up magnetic resonance image revealed no new ischemic changes. He experienced mild ataxia and sensory impairment and was transferred to a rehabilitation hospital on postoperative day 17 with a modified Rankin scale score of 2, which had improved to 1 on postoperative day 90. Conclusion: Accurate diagnostic imaging and an appropriate endovascular treatment technique led to good recovery in the present case. Even in patients with incomplete reperfusion, restoring blood flow to the perforating branches supplying the brainstem can aid in preventing brainstem infarction.

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