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Endovascular Treatment of Acute Ischemic Stroke - an Alternative Technique

Ivan Valkadinov, Djuliana Stoilova, Yavor Hinov, Simona Nizorkova, Chavdar Bachvarov

Abstract

Introduction: Stroke is the clinical term that defines the constellation of symptoms of brain infarction. The majority of ischemic stroke cases are due to embolism. The embolus usually originates from the extracranial territory (e.g. heart, carotid bifurcation), travels to the intracranial arteries and occludes the middle cerebral artery (MCA) in most cases, causing a territorial type of infarction, i.e. one including the cortex and the underlying subcortical white matter. The basal ganglia and internal capsule are sometimes also affected, depending on the portion of the artery that is engaged. Thus, typical neurological deficits and imaging signs develop. Spot diagnosis and on-time treatment are crucial for a good outcome.

Materials and Methods: In this case report we present two patients with ischemic stroke who were treated with intra-arterial thrombolysis and mechanical thrombectomy, and their respective outcomes. General and focal neurological symptoms were observed as well as classical imaging findings, e.g. hemiparesis, hemisensory deficits, horizontal gaze palsy, hyperdense MCA, loss of grey-white matter differentiation, etc.

Results: Emergency catheterization through the right femoral artery by the Seldinger technique was performed. The M1 (horizontal, sphenoidal) segment of the MCA, from the origin to the bifurcation/trifurcation, was involved in both cases. The lateral lenticulostriate arteries, which branch off the occluded M1 segment, were also secondarily impermeable. Fragmentation and local thrombolysis of the embolus were successful in both cases, with reperfusion of the whole territory supplied by the MCA and following improvement in the clinical findings and imaging studies. Both patients were discharged with only mild neurological deficits.

Conclusion: Our report demonstrates two classic cases of ischemic stroke, in which endovascular intra-arterial treatment was successful. The vast clinical improvement in both patients implies the relevance of performing this procedure in the setting of acute brain infarction.


Keywords

stroke, mechanical thrombectomy, intra-arterial thrombolysis


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