[Successful removal of clots from embolic carotid occlusion by aspiration with a syringe--case report].

An 84-year-old woman who had experienced a sudden onset of stupor and total aphasia and right-side hemiparesis was admitted to our institution. Emergency MR (diffusion-weighted images: DWIs) studies revealed ischemic changes in the territory of the left middle cerebral artery; findings from the perfusion-weighted images (PWIs) has suggested a reduction of the cerebral blood flow. In addition, the MR angiograms showed no signals in the left carotid-middle cerebral artery. An emergency removal of the clot the carotid artery was attempted after an adaptive determination of revascularization was performed using MRI (DWIs/PWIs) during the acute stage. An emergency cerebral angiography demonstrated occlusion of the left internal carotid artery (ICA). In order to prevent the migration of thrombus into the peripheral arteries, the proximal blood flow was blocked using a 9-F guiding catheter with a coaxial balloon. Manual aspiration through the catheter with a 10-ml syringe resulted in effective removal of the thrombus. The thrombus was thus removed successfully, and the cerebral angiography after clot removal therapy (CRT) demonstrated complete recanalization of the left ICA. The patient's National Institutes of Health Stroke score decreased from 25 to 1 at 8 days after clot removal and a good 3-month clinical outcome was achieved. CRT by simple aspiration may be considered as a feasible and effective treatment modality for patients with embolic carotid occlusion. Received: December 18, 2007, Accepted: June 4, 2008