The impact of recanalization on ischemic stroke outcome: A clinical case presentation

Abstract

Stroke remains the third most common cause of death in industrialized nations, and the single most common reason for permanent disability. Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rtPA, Alteplase) for the treatment of acute ischemic stroke within 4.5 h of onset is becoming a worldwide conventional standard of care. Thrombolytic stroke therapy is based on the “recanalization hypothesis” that reopening of occluded vessels improves clinical outcome in acute ischemic stroke through regional reperfusion and salvage of threatened tissues. However, intravenous thrombolysis is successful in approximately one-third of patients. Thrombaspiration through either a microcatheter, or a guiding catheter may be an option for a fresh nonadhesive clot. The use of mechanical thrombectomy devices in patients experiencing ischemic stroke and reocclusion after intravenous thrombolysis can now gain approval on the basis of recanalization, demonstrating better recanalization rates. We present a clinical case of IVT followed by re-occlusion, and intra-arterial thrombaspiration and stenting. After IVT was started, a significant improvement of the neurological deficit was observed. After the end of the fibrinolysis, the patient had severe deterioration of the symptoms. The patient underwent control CT of the head to exclude intracerebral hemorrhage – the CT was normal. Through a guiding catheter thrombaspiration and stenting was performed with effective reperfusion with reversal of the neurological deficits. Revascularization remains the most intuitive strategy to reverse ischemic injury associated with arterial occlusion in acute strokes. This case represents a valuable example of two recanalization therapies in acute ischemic stroke to improve clinical outcome by restoring anterograde perfusion and salvaging the ischemic brain.