КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ УСПЕШНОГО СОВМЕСТНОГО ПРОВЕДЕНИЯ ТРОМБОЛИТИЧЕСКОЙ ТЕРАПИИ, МЕХАНИЧЕСКОЙ ТРОМБОЭКСТРАКЦИИ И СТЕНТИРОВАНИЯ У ПАЦИЕНТА С ИШЕМИЧЕСКИМ ИНСУЛЬТОМ В БАССЕЙНЕ ПРАВОЙ СРЕДНЕЙ МОЗГОВОЙ АРТЕРИИ

Abstract

Abstract. Introduction. As of today, acute cerebrovascular accident is still the most important medical and social challenge in the modern society, due to its high growth rates of morbidity, disability, and mortality. A highly proven method of ischemic stroke treatment is reperfusion therapy, including intravenous thrombolytic therapy and mechanical thrombus extraction. Thrombus extraction is a high–tech medical procedure aimed at removing blood clots, which is the most effective way to treat patients with ischemic stroke. Aim. To illustrate the efficiency of collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. Materials and Methods. The article presents a clinical case report on a patient with ischemic stroke in the territory of the right middle cerebral artery upon the successful collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. The patient’s neurological status was assessed, and neuroimaging was performed before and after thrombolytic therapy, mechanical thrombus extraction, and stenting; laboratory tests and instrumental investigations were carried out, and secondary prevention was prescribed. Results and Discussion. Due to the successful staged reperfusion therapy including intravenous thrombolytic therapy followed by mechanical thrombus extraction using a stent retriever, and stenting of the right internal carotid artery, the physicians managed to achieve the restoration of blood flow along the right middle cerebral artery with significant clinical regression of neurological deficit, which achievement demonstrated the effectiveness, safety, and expediency of using this treatment technique. Combining these methods is efficient for the treatment of patients with ischemic stroke caused by the major artery occlusions in the anterior parts of Willis circle. In centers of vascular medicine where there is no high-tech medical care, thrombolytic therapy is administered intravenously in one medical institution, and then the patient is transferred to another one where it is possible to perform mechanical thrombus extraction, or both reperfusion therapy techniques can be used within one medical institution. Conclusions. Collaboratively performing the above procedures illustrates their high efficiency and safety. Time elapsed from the disease onset to the treatment initiation is essential to successful recanalization.