Repeated mechanical thrombectomy for acute ischemic stroke in a dialysis patient: A case report and literature review

Abstract

Mechanical thrombectomy (MT) can significantly improve the prognosis of patients with large vessel occlusion (LVO) stroke. It is still unclear whether repeated MT in a short period of time is safe and effective in patients with renal failure and atrial fibrillation (AF). We present the case of an LVO patient with AF and uremia who was successfully treated with MT for M1 segment occlusion of the right middle cerebral artery (MCA) and achieved a good outcome. Fifteen days after the first MT, the patient's stroke recurred; angiography at that time revealed M1 segment, and branch occlusion of the right MCA, and a second MT was performed. This patient was given oral warfarin to maintain her international normalized ratio (INR) between 2 and 3, and over a 9-month follow-up period, no further vascular events occurred. It may be safe and effective to perform repeated MTs in patients with uremia and AF who have suffered two cardiogenic strokes in a short period of time. It might be beneficial to treat a patient of this description with anticoagulant therapy after careful assessment of the patient's condition. Nephrologists and medical staff at hemodialysis centers should recognize the importance of MT for patients with acute ischemic stroke (AIS). In this way, health care providers can take measures in a timely, effective manner when they encounter hemodialysis patients with AIS.

Effect of butylphthalide on new cerebral microbleeds in patients with acute ischemic stroke

“…A number of studies have confirmed that endovascular therapy can significantly improve the prognosis of patients with large vessel occlusion stroke. [ 7 – 12 ] However, some patients outside the treatment window lose the chance of thrombolysis or endovascular therapy and even in patients receiving IVT or endovascular treatment, there are still a considerable number of patients with neurological deficits that have not been significantly improved, or even cannot benefit from treatment. Therefore, there is still much room for optimization in the treatment of AIS patients, and it is necessary to find effective drugs to improve the prognosis of AIS patients.…”