Mechanical Thrombectomy as First-line Endovascular Therapy for Acute Middle Cerebral Artery Occlusion Due to Arterial Dissection: A Case Report and Literature Review.

Isolated middle cerebral artery dissection is a rare cause of acute ischemic stroke, accounting for approximately 2.4% of anterior circulation events. Due to its rarity, no optimal management strategy has been established, and evidence regarding the safety and efficacy of endovascular therapy remains limited. We report a 26-year-old male who presented with sudden-onset headache, vomiting, right hemiparesis, and aphasia. Magnetic resonance imaging revealed multiple faint diffusion-restricted lesions in the left hemisphere (DWI-ASPECTS 7), and magnetic resonance angiography demonstrated occlusion of the left middle cerebral artery (M2 segment). Emergency mechanical thrombectomy using a combined stent retriever and aspiration technique achieved complete recanalization (Thrombolysis in Cerebral Infarction 3), although significant residual stenosis persisted. Balloon angioplasty restored satisfactory luminal patency without stent placement. Postoperative contrast-enhanced vessel wall imaging showed mural thickening and marked enhancement of the left M2 segment, confirming arterial dissection. The patient recovered well, and no infarct progression or re-occlusion occurred during the 6-month follow-up. The present case suggests that endovascular therapy employing mechanical thrombectomy as the first-line strategy may be one of the therapeutic options for acute middle cerebral artery occlusion secondary to arterial dissection. The procedural strategy and device selection should be individualized to minimize vessel injury. Furthermore, given the potential for dynamic vascular changes, long-term radiological surveillance remains essential.