Endovascular thrombectomy in acute-onset ischemic stroke-beyond the standard time windows: A case report and a review of the literature
JournalCase Reports in Neurology
PublisherS. Karger AG
MetadataShow full item record
AbstractEndovascular thrombectomy following an acute ischemic stroke can lead to improved functional outcome when performed early. Current guidelines suggest treatment within 6 h after symptom onset. Recent studies including the DEFUSE-3 and DAWN trials demonstrate that some patients may benefit from thrombectomy up to 16 and 24 h after symptom onset, respectively. We present a case of delayed thrombectomy in a 43-year-old man with acute dysarthria, left-sided weakness, and visual neglect. Initial MRI/A demonstrated a small completed stroke and a thrombus in the right middle cerebral artery. Thirty-seven hours after symptom onset, his weakness acutely worsened. A repeat MRI revealed an unchanged core infarct volume and a cerebral angiogram suggested an abrupt occlusion of the right distal M1. Thrombectomy was performed with complete reperfusion and the patient's strength recovered following the procedure. We compared our clinical reasoning with the DEFUSE-3 and DAWN study criteria, and conclude that there is a subset of patients that may safely benefit from thrombectomy in later time windows beyond the trial criteria, especially in the setting of clinical examination of imaging mismatch. Copyright 2018 The Author(s). Published by S. Karger AG, Basel.
Sponsorson this project were supported in part by NIH grants U01 NS069208, R01 NS100178, and R01 NS105150; the US Department of Veterans Affairs, and the American Heart Association Cardiovascular Genome-Phenome Study (grant No. 15GPSPG23770000), and an American Heart Association Discovery Grant supported by Bayer Group (grant No. 17IBDG33700328).
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85053907947&doi=10.1159%2f000492892&partnerID=40&md5=82c834f1ae4ecf587e421c7bf0ea258e; http://hdl.handle.net/10713/9062