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

Frontiers in Neurology
Simon FandlerThomas Gattringer

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.

References

Jan 12, 2010·Neuropharmacology·Rami Abu FanneAbd Al-Roof Higazi
Oct 9, 2014·Stroke; a Journal of Cerebral Circulation·Kety HsiehMarwan El-Koussy
Jun 17, 2015·Journal of the American Heart Association·Ajay GuptaHooman Kamel
Nov 4, 2015·JAMA : the Journal of the American Medical Association·Jetan H BadhiwalaSaleh A Almenawer
Jul 2, 2016·Stroke; a Journal of Cerebral Circulation·Timo KahlesKrassen Nedeltchev
Nov 9, 2016·Journal of Neurointerventional Surgery·María Alonso de LeciñanaBlanca Fuentes
Jun 15, 2017·Interventional Neurology·Mehdi BouslamaRaul G Nogueira

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Citations

Dec 24, 2019·Stroke; a Journal of Cerebral Circulation·France Anne Victoire PirsonJulie Staals
Mar 19, 2020·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Andrej KlepanecGeorgi Krastev
Dec 12, 2019·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·B IkenbergC Maegerlein
Sep 24, 2020·Journal of the Formosan Medical Association = Taiwan Yi Zhi·Sung-Ju HsuehJiann-Shing Jeng
Nov 15, 2020·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Hyun Jin LeeJung-Soo Park
Apr 30, 2021·Stroke; a Journal of Cerebral Circulation·Ghada A MohamedAlex Bou Chebl

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