Open AccessDelayed treatment for a case of acute ischaemic stroke using mechanical embolectomy — the L5 Merci Retriever
Author(s) -
Velkovic J,
McEwan S,
Coulthard A
Publication year - 2009
Publication title -
radiographer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.484
H-Index - 18
eISSN - 2051-3909
pISSN - 0033-8273
DOI - 10.1002/j.2051-3909.2009.tb00100.x
Subject(s) - medicine , thrombolysis , embolectomy , timi , stroke (engine) , surgery , penumbra , anesthesia , cardiology , myocardial infarction , pulmonary embolism , ischemia , mechanical engineering , engineering
Endovascular therapies for acute ischaemic stroke represent important alternatives or adjuncts to thrombolysis. A middle‐aged male suffered a Thrombolysis in Myocardial Infarction (TIMI) Grade 0 distal left middle cerebral artery (LMCA) occlusion resulting in right hemiparesis and dysphasia. Intravenous thrombolysis was contraindicated due to pre‐existing anticoagulant therapy and associated risk of intracranial haemorrhage. The patient underwent rescue mechanical embolectomy with an L5 Merci Retriever, with adjuvant local intra‐arterial (IA) thrombolysis. Successful TIMI Grade 3 restoration of LMCA blood flow occurred within eight hours of ictus. Aphasia resolved within 24 hours, whilst other motor and speech symptoms gradually improved over 6 months, allowing the patient to resume work and independent living. Mechanical embolectomy appears to be a safe and effective alternative in cases of delayed presentation, or where intravenous thrombolysis is contraindicated. Combined mechanical embolectomy and adjuvant IA thrombolysis, instituted within eight hours of ictus in an anticoagulated patient, achieved favourable clinical outcome (modified Rankin Score of 2) without major thromboembolic or haemorrhagic complications.