Repeated Mechanical Thrombectomy in the Same Intracranial Artery Segment

Meza, H. Tejada; Caballo, María Rosario Barrena; Morte, Santiago Guelbenzu; García, R. Martínez; Moreno, J. Marta

doi:10.1016/j.jstrokecerebrovasdis.2017.06.015

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…Imagine analysis in the CTA still supported us to continue with the second consecutive thrombectomy. This decision was similar to the ones done by other authors [3], [4], [5]. After discharge, our patient was prescribed continuously Xarelto, but she changed into Aspirin by herself without any consultant with us.…”

Section: Discussionsupporting

confidence: 64%

Multiple Recurrent Acute Ischemic Strokes Treated by Thrombectomy in a Patient with Acute Pulmonary Embolism

Duy¹,

Vu²,

Viet³

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: Thrombectomy is recommended to treat for an acute ischemic stroke (AIS) patient with anterior large vessel occlusion. However, there were neither detailed guidelines nor systematic reviews of acute ischemic stroke patients having multiple times or re-occluded arteries. CASE REPORT: In our case report, we struggled a multiple (4-times) AIS patient underwent by one intravenous r-tpA and 3 remaining of endovascular treatment of thrombectomy. Especially, the finding of both pulmonary embolism and cerebral arteries occlusion in this patient made us difficult to decide the appropriate treatment plan. The patient was considered having multiple cardiac thrombi pumping out to the brain and pulmonary vessels even in treatment with NOAC (New Oral Anticoagulant). Our priority, normally, was to recanalize the brain vessels compared to the pulmonary arteries. CONCLUSION: In conclusion, based on this noticed case study, we want to share our experiences on the diagnosis of ischemic stroke, the strategy in treatment and prevention with anticoagulant therapy.

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Section: Discussionsupporting

confidence: 64%

Multiple Recurrent Acute Ischemic Strokes Treated by Thrombectomy in a Patient with Acute Pulmonary Embolism

Duy¹,

Vu²,

Viet³

et al. 2019

Open Access Maced J Med Sci

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“…Without early recanalization, the prognosis of acute BAO is usually very poor. As the collateral circulation of the posterior circulation was more abundant compared to anterior circulation, it has been argued that the thrombolysis time window can potentially be prolonged in posterior circulation stroke [5]. Several studies suggested that recanalization therapies for BAO can potentially benefit patients up to 12–24 h after symptom onset [6-8].…”

Section: Discussionmentioning

confidence: 99%

“…Our patient with acute posterior circulation infarction and underlying ICAD underwent ET of the same occluded BA thrice within 24 h. Data on repeated ET for early recurrent stroke caused by the occlusion of the same affected vessel are scarce. To our knowledge, there are only a few case reports [3-5, 12] and two retrospective studies with repeated ET due to recurrent LVO [13, 14], but mostly in the anterior circulation. Our case report is the first on repeated ET within the BA.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Successful Intravenous Thrombolysis Bridged with Repeated Endovascular Treatment in Acute Basilar Artery Occlusion

et al. 2020

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Acute basilar artery occlusion (BAO) is a neurological emergency that has a high rate of mortality and poor functional outcome. Endovascular therapy (ET) is the gold standard therapy for large vessel occlusion stroke of the anterior circulation. Whether ET can also be effectively and safely performed in early recurrent large vessel occlusion, especially in BAO, is unclear. We describe a case of successful recanalization and independent functional outcome of a BAO patient treated with intravenous thrombolysis combined with repeated ET. The patients was a 32-year-old man with a history of heavy smoking and drinking who presented to the Emergency Department with dizziness and hypertension, and progressed over the next 13 h to left hemiparesis and mild dysarthria with an NIHSS score of 7. CT angiography demonstrated occlusion of the proximal basilar artery (BA). Intravenous alteplase was given followed by ET. The first intervention failed and over the next 8 h, the patient’s NIHSS score increased to 12. A second attempt with balloon angioplasty managed to reconstitute arterial blood flow with a severe residual stenosis of the proximal BA. Subsequently, the patient progressed into deep coma with reocclusion of the BA demonstrated on transcranial Doppler. A third intervention with emergent stenting resulted in complete recanalization of the BA and excellent neurological recovery. This patient received three endovascular treatments within 24 h due to reocclusion of the BA and achieved good outcomes. In conclusion, repeated ET for early recurrent BAO is feasible in carefully selected patients.

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Endovascular treatment of acute ischemic stroke in patients with recurrent intracranial large vessel occlusion

et al. 2020

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Background Data on the treatment with recurrent mechanical thrombectomy of patients with acute ischemic stroke with recurrent large vessel occlusion are limited. We report our experience with recurrent mechanical thrombectomy for recurrent large vessel occlusion. Methods During the period between May 2013 and August 2018, data on patients with recurrent large vessel occlusion were collected. Baseline clinical characteristics, recanalization technique, recanalization rates and clinical outcomes of patients with recurrent large vessel occlusion treated with mechanical thrombectomy were analyzed. Patients with recurrent large vessel occlusion treated with mechanical thrombectomy were compared with patients who underwent single mechanical thrombectomy. Results During the study period, 7 of 474 patients (1.5%) were treated with mechanical thrombectomy for recurrent large vessel occlusion. The mean age of these patients was 64.4 (±7.9) years, and the mean time interval between thrombectomies was 47 (±48) h. The median baseline National Institutes of Health Stroke Scale (NIHSS) was 12 (range 5–24) before the first and 20 (range 3–34) before the second procedure; the mean NIHSS at discharge was 5 (range 2–25). Good clinical outcome after repeated mechanical thrombectomy defined as modified Rankin scale of 0–2 was achieved in 29% of patients at three months of follow-up. Conclusions Repeat mechanical thrombectomy is a rare procedure, but appears to be a feasible, safe and effective treatment option in patients with acute ischemic stroke and early recurrent large vessel occlusion.

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Repeated Mechanical Thrombectomy in the Same Intracranial Artery Segment

Cited by 5 publications

References 3 publications

Multiple Recurrent Acute Ischemic Strokes Treated by Thrombectomy in a Patient with Acute Pulmonary Embolism

Multiple Recurrent Acute Ischemic Strokes Treated by Thrombectomy in a Patient with Acute Pulmonary Embolism

A Case of Successful Intravenous Thrombolysis Bridged with Repeated Endovascular Treatment in Acute Basilar Artery Occlusion

Endovascular treatment of acute ischemic stroke in patients with recurrent intracranial large vessel occlusion

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