Trans-Anterior Communicating Artery Primary Stenting in Acute Tandem Middle Cerebral Artery–Internal Carotid Artery Occlusion Due to Thoracic Aortic Stent Graft

Background The main target of stroke intervention is the revascularization of occluded vessels, usually achieved with thrombectomy or thrombus aspiration. Despite good results in limited series, intracranial primary stenting is controversial for increased hemorrhagic risk owing to the need for dual antiplatelet therapy. Case Description We present a case of trans-anterior communicating artery primary stenting in an acute tandem middle cerebral artery–internal carotid artery occlusion in a patient harboring a thoracic aortic stent graft partially covering the origin of the left common carotid artery. Conclusion Our experience with this patient demonstrates that primary intracranial stenting shoud be considered in selected cases when other revascularization techniques are difficult or impossible to perform owing to anatomic reasons. Extreme care should be taken in patient selection because of the risks associated with antiplatelet therapy. In particular, it may be recommended in patients with a small core on computed tomography perfusion or diffusion-weighted magnetic resonance imaging and in whom thrombectomy and thromboaspiration are impossible for anatomic reasons.