Presentation
Acute onset right hemiparesis (arm>leg) and severe dysphasia. Imaging 2 hours after presentation to ED, but 9 hours past last seen well. Background cardiomyopathy.
Patient Data
Small core large pefusion defect. Minmal early change, HMCAS ICA-M1. CTA ICA "T" occlusion
ICA occlusion to M1. Balloon guide catheter, 6*30 stentriever placed, single pass with clot on device and in aspirate. TICI3.
Case Discussion
Good recanalization with NIHSS 2 following day, almost complete recovery of speech day 2, subtle dyspraxia RUL, 4+/5 power.
Usually, last known well time is taken as onset for decisions regarding IV TPA and endovascular clot retrieval. The benefit of ECR for large vessel occlusion is to great - with NNT 3-4, that patients outside some of the timelines used in the 2015 published trials will still benefit. For young patient, significant deficit, imaging concordant with the considered 2 hours onset (wake up stroke), ECR should be considered, or patients entered into specific trials investigating this subgroup. Logistics in this instance argued for treatment rather than transfer for possible trial inclusion.
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