Cardioembolic stroke in Takayasu arteritis treated with dual stent retriever via brachial access: A case report

Takayasu arteritis (TA) is a large-vessel vasculitis that may predispose to ischemic stroke through arterial stenosis, dissection, in-situ thrombosis, or cardiac embolism. We report the case of a 36-year-old man with TA who presented with acute left hemiplegia due to right MCA M1 occlusion. Because of extensive aortoiliac disease, mechanical thrombectomy was performed via right brachial access using two stent retrievers across the M1 bifurcation, achieving single-pass complete reperfusion (mTICI 3). Post-procedural echocardiography revealed a large mobile apical left-ventricular thrombus, indicating a cardioembolic mechanism, and anticoagulation was initiated. The patient recovered to NIHSS 0 at discharge and mRS 1 at 3 months. This case highlights the feasibility of brachial access and dual stent retriever technique in TA patients with inaccessible femoral arteries, and underscores the importance of individualized access and device strategies in complex vascular anatomy.