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Mechanical thrombectomy through a ‘carotid–carotid bypass’
  1. Prashanth Reddy1,
  2. Mudassar Kamran2 and
  3. Satya Narayana Patro2
  1. 1Neuroradiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  2. 2Interventional Neuroradiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  1. Correspondence to Dr Satya Narayana Patro; drsatyanpatro{at}


An elderly patient presented with acute-onset right-sided weakness and aphasia. A large penumbra was noted in the left middle cerebral artery (MCA) territory without any infarct core. The patient was noted to have a carotid–carotid bypass. This posed certain technical challenge in accessing the intracranial circulation across the carotid bypass; however, the guiding catheter with soft distal segment was successfully navigated coaxially over the aspiration catheter across the bypass and intracranial circulation was accessed for mechanical thrombectomy. Complete recanalisation and reperfusion were achieved with significant neurological recovery of the patient post-thrombectomy. The aim of this report is to emphasise on this rarely encountered situation in thrombectomy and its successful management. The procedure should not be delayed or deferred due to lack of operator experience.

  • neuroimaging
  • stroke
  • interventional radiology

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  • Contributors PR: manuscript development, image preparation, literature review; MK: patient management, literature review; SNP: patient management, manuscript review, image review, literature review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.