Thrombectomy for ischemic stroke with large vessel occlusion and concomitant subarachnoid hemorrhage.

Journal of Thrombosis and Thrombolysis
Cecilia ZivelonghiManuel Cappellari

Abstract

To report our experience in treating one patient with nontraumatic subarachnoid hemorrhage (SAH) and concurrent acute ischemic stroke (AIS) due to large vessels occlusion (LVO). A man in his 50 s presented with acute right hemiparesis and aphasia. Brain CT showed a SAH in the left central sulcus; CT-angiography revealed a tandem occlusion of the left internal carotid artery and homolateral middle cerebral artery. He underwent an angiographic procedure with successful recanalization. Follow-up CT demonstrated a striatal-lenticular stroke without SAH progression. While the absolute contraindication to IVT during intracranial bleeding remains unquestionable, the potential injury/benefit from MT is still debatable. Such cases constitute a blind spot in the guidelines where physicians face the dilemma of choosing between an acute endovascular treatment with the risks of hemorrhage progression and a conservative treatment with the associated poor clinical outcome. We decided to treat our patient invasively, considering the young age, also given the absence of prognostic factors that generally predict post-procedural reperfusion injury. We believe that, in similar cases, MT should be considered-despite not free of risks and drawbacks-...Continue Reading

References

Jan 23, 2010·AJNR. American Journal of Neuroradiology·V CuvinciucF Bonneville
Mar 19, 2014·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Makoto NakajimaYukio Ando
May 22, 2017·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Stefano ForlivesiManuel Cappellari
Nov 25, 2017·International Journal of Stroke : Official Journal of the International Stroke Society·Joyce S BalamiAlastair M Buchan
Dec 12, 2018·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Johannes M WellerFelix J Bode
Apr 3, 2019·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Alessandro IntronaIsabella Laura Simone

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