Acute left ICA and M1 occlusion treated with mechanical thrombectomy

Case contributed by Dr Hadio Ali Khazatsin

Presentation

Acute right extremity weakness (1/5 power) and right facial weakness for 2 hours before admission. History of hypertension and atherosclerosis. Initially treated with standard IV rt-PA but failed to achieve significant improvement. We decide to perform emergency mechanical thrombectomy.

Patient Data

Age: 90 years
Gender: Male

Single slice of the admission CT. No convincing features of acute infarct.

DWI sequence demonstrates acute left MCA territory ischaemic stroke.

Interventional cerebral angiography with mechanical thrombectomy.

Left ICA occlusion which was recanalised using aspiration device.

Further occlusion in left M1 (annotated), possibly migrated from left ICA after aspiration. Simultaneous stent retriever and aspiration technique used.

The clot was successfully retrieved and with no immediate complications.

Thrombus retrieved after left M1 mechanical thrombectomy.

Scan acquired soon post-thrombectomy.

Despite recanalisation, there is evidence of left MCA territory infarct with hypoattenuating brain, loss of cortical differentiation and mass effect. Similar territory as the restricted diffusion on pre-treatment DWI sequence.

Case Discussion

Left ICA occlusion, with further thrombus seen in M1 segment after clot aspiration.

Clinical improvement with 3/5 right sided power.

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Disclosure: I, Hadio Ali Khazatsin, have no actual or potential ethical or financial conflict of interest in relation to this product. This case is not intended to be a personal endorsement or recommendation of this product.

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Case information

rID: 56085
Case created: 10th Oct 2017
Last edited: 15th Oct 2017
Inclusion in quiz mode: Included
Institution: University of Medicine and Pharmacy, Ho Chi Minh City

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