Abstract
Mechanical thrombectomy (MT) is the gold standard treatment for large vessel occlusion (LVO) stroke of the anterior circulation. Whether MT can also be effectively and safely performed in early recurrent LVO is largely unclear. We present the case of a middle-aged patient who was successfully treated by MT for right proximal middle cerebral artery (MCA) occlusion with excellent outcome. One day after discharge (9 days after the first MT), the patient was readmitted with wake-up stroke. MRI again revealed right proximal MCA occlusion with severe diffusion–perfusion mismatch. Repeat MT was performed and once more led to almost full recovery. The recurrent strokes were attributed to ulcerated non-stenosing plaques in the ipsilateral internal carotid artery, which prompted thromboendarterectomy. In an 18-months follow-up period, no further vascular events occurred. In conclusion, repeated MT for early recurrent LVO appears feasible in carefully selected patients. The collection of similar cases via registries would be desirable.
Highlights
Mechanical thrombectomy (MT) in combination with intravenous thrombolysis (IVT) has become the gold standard treatment for acute ischemic stroke due to proximal large vessel occlusion (LVO) of the anterior circulation [1]
Intravenous thrombolysis is generally contraindicated in patients with a history of stroke within the last 3 months because of the assumed higher risk of intracranial hemorrhage
The repeated use of IVT in early recurrent stroke might pose a risk, a small case series has shown that repeated IVT can be safely and effectively administered in carefully selected patients [3]
Summary
Mechanical thrombectomy (MT) in combination with intravenous thrombolysis (IVT) has become the gold standard treatment for acute ischemic stroke due to proximal large vessel occlusion (LVO) of the anterior circulation [1]. The repeated use of IVT in early recurrent stroke might pose a risk, a small case series has shown that repeated IVT can be safely and effectively administered in carefully selected patients [3]. In such a situation, MT might be an option. Mechanical thrombectomy was successfully performed using a Solitaire stent retriever (thrombolysis in cerebral infarction scale 3, Figures 1A–B). Performed with a Solitaire stent retriever (door-to-recanalization time: 149 min, thrombolysis in cerebral infarction scale 3, Figures 2D–E). Repeated neurological follow-up examinations were performed at 3, 6, and 18 months, each showing no further vascular events and stable neurosonographic findings
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