Mechanical Thrombectomy of the Left Brachial Artery for Graft Occlusion after Debranching Thoracic Endovascular Aortic Repair: A Case Report

In patients who have undergone debranching thoracic endovascular aortic repair, the access route and system for mechanical thrombectomy must be carefully selected on a case-by-case basis. We report an 82-year-old man in whom mechanical thrombectomy was successfully performed via the left brachial artery for occlusion of a bypass graft. He was admitted with impaired consciousness and was diagnosed with left common carotid artery occlusion on magnetic resonance angiography. The patient had previously undergone debranching thoracic endovascular aortic repair with a right subclavian artery–left common carotid artery–left subclavian artery bypass for a thoracic aortic aneurysm 4 years earlier. Because a femoral artery approach was considered unfeasible, mechanical thrombectomy was performed via the left brachial artery. A 6 Fr guiding sheath was advanced into the left brachial artery, and angiography demonstrated that both the bypass graft to the left common carotid artery and the left common carotid artery itself were occluded by a large thrombus. Multiple mechanical thrombectomy attempts using various techniques were performed, and a thrombus measuring approximately 3 cm was retrieved, resulting in successful grade 2c Thrombolysis in Cerebral Infarction reperfusion. For patients who have undergone debranching thoracic endovascular aortic repair, the brachial approach may be considered as a potential alternative when femoral access is not feasible. The choice of access route might be influenced by the specific type of cervical vascular reconstruction and the location of the lesion.