Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset

Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset

A 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological...

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Main Authors: Anelia Dietmann, Kety Wha-Vei Hsieh, Andrea M. Humm, Claudio L. Bassetti, Urs Fischer, Jan Gralla
Format: Article
Language:English
Published: Hindawi Limited 2017-01-01
Series:Case Reports in Neurological Medicine
Online Access:http://dx.doi.org/10.1155/2017/9289218
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spelling doaj-a9c36f0f9f2749a6a062142f88b4a8122020-11-25T00:30:57ZengHindawi LimitedCase Reports in Neurological Medicine2090-66682090-66762017-01-01201710.1155/2017/92892189289218Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke OnsetAnelia Dietmann0Kety Wha-Vei Hsieh1Andrea M. Humm2Claudio L. Bassetti3Urs Fischer4Jan Gralla5Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandA 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological deficits no IVT was performed. Nine hours after symptom onset the patient gradually deteriorated with a NIHSS fluctuating between 9 and 15. MRI showed a persistent occlusion of the MCA with a large diffusion-perfusion mismatch. Immediate endovascular thrombectomy was performed 14 hours after symptom onset with complete recanalization and complete clinical recovery. Although mechanical thrombectomy is generally considered an effective alternative strategy up to 8 hours after stroke onset, selected patients with a large diffusion/perfusion mismatch and small infarct cores may benefit from an expanded therapeutic window.http://dx.doi.org/10.1155/2017/9289218
collection DOAJ
language English
format Article
sources DOAJ
author Anelia Dietmann
Kety Wha-Vei Hsieh
Andrea M. Humm
Claudio L. Bassetti
Urs Fischer
Jan Gralla
spellingShingle Anelia Dietmann
Kety Wha-Vei Hsieh
Andrea M. Humm
Claudio L. Bassetti
Urs Fischer
Jan Gralla
Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset
Case Reports in Neurological Medicine
author_facet Anelia Dietmann
Kety Wha-Vei Hsieh
Andrea M. Humm
Claudio L. Bassetti
Urs Fischer
Jan Gralla
author_sort Anelia Dietmann
title Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset
title_short Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset
title_full Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset
title_fullStr Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset
title_full_unstemmed Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset
title_sort successful mechanical thrombectomy of a middle cerebral artery occlusion 14 hours after stroke onset
publisher Hindawi Limited
series Case Reports in Neurological Medicine
issn 2090-6668
2090-6676
publishDate 2017-01-01
description A 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological deficits no IVT was performed. Nine hours after symptom onset the patient gradually deteriorated with a NIHSS fluctuating between 9 and 15. MRI showed a persistent occlusion of the MCA with a large diffusion-perfusion mismatch. Immediate endovascular thrombectomy was performed 14 hours after symptom onset with complete recanalization and complete clinical recovery. Although mechanical thrombectomy is generally considered an effective alternative strategy up to 8 hours after stroke onset, selected patients with a large diffusion/perfusion mismatch and small infarct cores may benefit from an expanded therapeutic window.
url http://dx.doi.org/10.1155/2017/9289218
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