Fenestration of the middle cerebral artery (MCA) is a rare anatomic variant, and lenticulostriate arteries (LSAs) often arise from the superior limb of the fenestrated segment. A case of acute occlusion of the superior limb of a fenestrated MCA that successfully underwent mechanical thrombectomy is presented. Digital subtraction angiography performed for a 73-year-old man with acute left hemiparesis showed poor visualization of the upper half of the right M1 segment with maintenance of antegrade peripheral circulation of the MCA territory, and mechanical thrombectomy was successfully performed using a stent retriever with intravenous thrombolysis. After restoration of the MCA, the vascular variant of a fenestrated MCA was found. Clinicians must consider the possibility of acute occlusion of a fenestrated MCA before endovascular thrombectomy. Restoration of acute occlusion of the upper limb of a fenestrated MCA can avoid LSA territory infarction.
Keywords: 3D-FIESTA, 3-dimensional fast imaging employing steady-state acquisition; AIS, acute ischemic stroke; Acute stroke; BPAS, basi-parallel anatomic scanning; CT, computed tomography; DSA, digital subtraction angiography; Fenestration; LSA, lenticulostriate artery; MCA, middle cerebral artery; Mechanical thrombectomy; Middle cerebral artery; NIHSS, national institutes of health stroke scale; Superior limb; mRS, modified Rankin scale.
© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.