Thrombectomy of the Anterior Cerebral Artery Through a Trans-Anterior Communicating Artery Approach: A Case Report

Objective: Acute anterior cerebral artery (ACA) occlusion is a rare condition and sometimes leads to significant neurological deficits. Mechanical thrombectomy through the ipsilateral carotid artery can achieve recanalization in most acute occlusions of the anterior cerebral artery. However, ipsilateral carotid artery occlusion will significantly increase the difficulty and risk of thrombectomy of the anterior cerebral artery. Case presentation: A 50-year-old man presented with a sudden onset of right hemiparesis, dysarthria, and symptoms of confusion. Computed tomographic angiography revealed acute left ACA occlusion and chronic occlusion of the ipsilateral internal carotid artery. Thrombectomy of the ipsilateral anterior cerebral artery via the occluded internal carotid artery is both difficult and time-consuming. We performed thrombectomy of the left anterior cerebral artery through the right internal carotid artery via the anterior communicating artery. The target vessel was successfully recanalized and the patient achieved good results. There is no report about thrombectomy of contralateral anterior cerebral artery through the anterior communicating artery. Conclusion: This case prompt that it is feasible to use the anterior communicating artery as the thrombectomy path for the contralateral anterior cerebral artery distal medium vessel occlusion.