Recurrent Cardioembolic Stroke Treated Successfully with Repeated Mechanical Thrombectomy within the Acute Index Stroke Period

Abstract

BackgroundThe safety of repeated mechanical thrombectomy within the acute stroke period has not yet been clearly demonstrated. We describe herein a patient who was successfully treated with repeated mechanical thrombectomy within the acute index stroke period.Case ReportA 50-year-old woman with atrial fibrillation presented with left-sided weakness caused by occlusion of the right middle cerebral artery (MCA). Emergent mechanical thrombectomy with the Solitaire device achieved complete recanalization. The left MCA occlusion redeveloped at 6 days after the first treatment, at which time her international normalized ratio (INR) was 2.3. Endovascular thrombectomy was reattempted rapidly and complete recanalization was achieved again. Her neurologic symptoms resolved after the thrombectomy.ConclusionsThis case demonstrates that repeated mechanical thrombectomy can be safely and successfully performed even in a patient with a high INR and a recurrent stroke during the acute period after the index stroke.

Repeated Mechanical Thrombectomy in Recurrent Large Vessel Occlusion Acute Ischemic Stroke

“…Data regarding the repeated use of intra-arterial treatment (IAT) is limited to a total of 5 cases [4,7,8,9]. Four of these patients underwent 2 IAT and one was treated thrice.…”

“…Although repeated thrombolytic therapy has been reported safe and beneficial for recurrent strokes [3,4,5,6], the data regarding repeat thrombectomy (RT) is scarce and limited to a few case reports [7,8,9]; therefore, its safety and potential efficacy remain elusive. We aim to report our local experience with RT for recurrent LVOS.…”

Repeated Endovascular Treatment of Early Recurrent Proximal Middle Cerebral Artery Occlusion: Case Report and Brief Review of the Literature

“…In such a situation, MT might be an option. However, this has not yet been systematically evaluated and there are only few publications on repeated thrombectomies for LVO stroke ( 4 – 6 ). Data on repeated MT for early recurrent stroke caused by the occlusion of the same affected vessel are especially scarce.…”

Recurrencia precoz de infarto cardioembólico tratada con éxito mediante una segunda trombectomía

“…De hecho, hasta donde sabemos, solo se han publicado 2 casos que describen el posible beneficio de una trombectomía de repetición durante el periodo agudo del ictus 9 En este sentido, nuestro paciente fue sometido a la segunda trombectomía más temprana en ictus cardioembó-lico de repetición, logrando un resultado clínico aceptable, y sin complicaciones relacionadas con el procedimiento. Por ello, creemos que nuestro caso apoya la posibilidad de que la trombectomía mecánica sea un procedimiento seguro en los casos con reinfarto precoz, permitiendo mejores resultados funcionales en un subgrupo de pacientes sin otra alternativa terapéutica.…”