Bilateral Mechanical Thrombectomies for Simultaneous MCA Occlusions.
Publication/Presentation Date
12-1-2019
Abstract
BACKGROUND: Bilateral hemispheric dysfunction is devastating to consciousness. We present a unique case of a patient who developed bilateral middle cerebral artery infarcts with significant neurological improvement post bilateral thrombolysis in cerebral infarction (TICI) 3 thrombectomies.
CASE DESCRIPTION: The patient is a 64-year-old woman who presented 3 hours after her husband was awakened and found her with left hemiplegia. She had a history of atrial fibrillation and had her apixaban held for 5 days before the coronary angiogram that she received the day before arrival. Upon presentation, she was antigravity on the right side and withdrawing on the left side. Computed tomography angiogram showed a right M1 occlusion and an left M2 occlusion. Computed tomography perfusion revealed a mismatch with large penumbra, and she was taken for mechanical thrombectomy. Mechanical thrombectomy was performed using a combination of stent retriever and aspiration catheter with a TICI 3 revascularization. By the following morning, the patient was full strength on the right and antigravity on the left with a left facial droop. The patient recovered her speech and was fully oriented before leaving for rehabilitation on postoperative day 3.
CONCLUSIONS: The transient hypercoagulable state that was created with the withdrawal of apixaban likely increased our patient's risk of stroke. The literature supports continuing oral anticoagulants for endovascular procedures. The devastating consequences of thromboembolic events, whether stroke or pulmonary embolism, can be catastrophic, but luckily, mechanical thrombectomy provides the means to minimize the morbidity and mortality from bilateral infarctions.
Volume
132
First Page
165
Last Page
168
ISSN
1878-8769
Published In/Presented At
Storey, C., Lebovitz, J., Sweid, A., Tjoumakaris, S., Gooch, R., Rosenwasser, R. H., & Jabbour, P. (2019). Bilateral Mechanical Thrombectomies for Simultaneous MCA Occlusions. World neurosurgery, 132, 165–168. https://doi.org/10.1016/j.wneu.2019.08.236
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
31505295
Department(s)
Administration and Leadership
Document Type
Article