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

Abstract

Mechanical thrombectomy (MT) is the gold standard treatment for large vessel occlusion (LVO) stroke of the anterior circulation. Whether MT can also be effectively and safely performed in early recurrent LVO is largely unclear. We present the case of a middle-aged patient who was successfully treated by MT for right proximal middle cerebral artery (MCA) occlusion with excellent outcome. One day after discharge (9 days after the first MT), the patient was readmitted with wake-up stroke. MRI again revealed right proximal MCA occlusion with severe diffusion–perfusion mismatch. Repeat MT was performed and once more led to almost full recovery. The recurrent strokes were attributed to ulcerated non-stenosing plaques in the ipsilateral internal carotid artery, which prompted thromboendarterectomy. In an 18-months follow-up period, no further vascular events occurred. In conclusion, repeated MT for early recurrent LVO appears feasible in carefully selected patients. The collection of similar cases via registries would be desirable.

Repeated Mechanical Thrombectomy of Recurrent Large Vessel Occlusion: Case Report and Brief Review of the Literature

“…To our knowledge there are reports of repeated MT in patients with AIS [3,6]. However, no patients with AIS complicated with uremia undergoing repeated MT treatments in a short time were reported.…”

“…Fortunately, endovascular mechanical thrombectomy (MT) can significantly improve the prognosis of patients with LVO stroke [1,2]. In addition, for LVO recurring in the short term, it is possible to perform repeated MTs [3]. However, patients with end-stage renal disease undergoing maintenance dialysis have a higher incidence of both ischemic and hemorrhagic stroke than the general population [4,5], there have been no reports of repeated MT for LVO patients with dialysis.…”

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

“…13 Those investigators report that, although repeated thrombectomy may exacerbate damage to the vascular endothelium, which increases the risk of complications such as vasospasm, arterial dissection and ICH, repeated MT therapy for early recurrence of LVO seems feasible in carefully selected patients. 13 Those investigators report that, although repeated thrombectomy may exacerbate damage to the vascular endothelium, which increases the risk of complications such as vasospasm, arterial dissection and ICH, repeated MT therapy for early recurrence of LVO seems feasible in carefully selected patients.…”

“…Fandler et al reported a patient who underwent MT and achieved good outcome after two LVOs in 9 days. 13 Those investigators report that, although repeated thrombectomy may exacerbate damage to the vascular endothelium, which increases the risk of complications such as vasospasm, arterial dissection and ICH, repeated MT therapy for early recurrence of LVO seems feasible in carefully selected patients. However, the patient in that report did not have renal failure.…”

Mechanical thrombectomy for recurrent large vessel occlusion

“…Despite the wealth of data that has been obtained from the major trials and numerous case series, there remain unanswered questions including the safety and necessity of repeat thrombectomy. Previous studies have shown that repeat thrombolytic therapy is safe [18][19][20][21][22], however, there is limited data on the safety of recurrent mechanical thrombectomy [23][24][25][26].…”