Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2013

Open Access 01-12-2013 | Case report

Mechanical thrombectomy – an alternative treatment option in a patient with acute ischemic stroke and multiple contraindications for systemic thrombolysis: a case report

Authors: Katrin Christina Sczesni, Reinhard Wiebringhaus, Lothar Heuser, Sabine Skodda, Jens Eyding

Published in: Journal of Medical Case Reports | Issue 1/2013

Login to get access

Abstract

Introduction

Acute ischemic stroke is a common cause of disability and death in developed countries. Standard therapy for patients who present within 4.5 hours from the onset of symptoms is intravenous thrombolysis if contraindications such as oral anticoagulation, cancer or recent surgery are ruled out. Apart from that, mechanical recanalization is a new treatment option for patients with occlusion of major cerebral arteries as a cause of ischemic stroke.

Case presentation

In this case report we describe a 55-year-old Caucasian man with a right hemispheric ischemic syndrome who presented in time but who had multiple contraindications against systemic thrombolysis. He was then treated with mechanical recanalization and recovered. On discharge from the hospital he had only a slight left-sided facial paresis and discrete impairment of motion smoothness in his left hand.

Conclusion

We conclude that multimodal imaging should be performed in all patients with an acute onset of neurological symptoms suspicious of ischemic stroke, even if they have contraindications against an intravenous thrombolytic treatment.
Appendix
Available only for authorised users
Literature
1.
go back to reference Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, ECASS Investigators: Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008, 359 (13): 1317-1329. 10.1056/NEJMoa0804656.CrossRefPubMed Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, ECASS Investigators: Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008, 359 (13): 1317-1329. 10.1056/NEJMoa0804656.CrossRefPubMed
2.
go back to reference Wahlgren N, Ahmed N, Davalos A, Hacke W, Millán M, Muir K, Roine RO, Toni D, Lees KR, SITS investigators: Thrombolysis with alteplase 3–4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. Lancet. 2008, 372 (9646): 1303-1309. 10.1016/S0140-6736(08)61339-2. published online first: 12 September 2008CrossRefPubMed Wahlgren N, Ahmed N, Davalos A, Hacke W, Millán M, Muir K, Roine RO, Toni D, Lees KR, SITS investigators: Thrombolysis with alteplase 3–4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. Lancet. 2008, 372 (9646): 1303-1309. 10.1016/S0140-6736(08)61339-2. published online first: 12 September 2008CrossRefPubMed
3.
go back to reference Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G, ECASS: Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010, 375 (9727): 1695-1703. 10.1016/S0140-6736(10)60491-6.CrossRefPubMed Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G, ECASS: Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010, 375 (9727): 1695-1703. 10.1016/S0140-6736(10)60491-6.CrossRefPubMed
4.
go back to reference Rubiera M, Ribo M, Pagola J, Coscojuela P, Rodriguez-Luna D, Maisterra O, Ibarra B, Piñeiro S, Meler P, Romero FJ, Alvarez-Sabin J, Molina CA: Bridging intravenous-intra-arterial rescue strategy increases recanalization and the likelihood of a good outcome in nonresponder intravenous tissue plasminogen activator-treated patients: a case–control study. Stroke. 2011, 42 (4): 993-997. 10.1161/STROKEAHA.110.597104. published online first: 3 March 2011CrossRefPubMed Rubiera M, Ribo M, Pagola J, Coscojuela P, Rodriguez-Luna D, Maisterra O, Ibarra B, Piñeiro S, Meler P, Romero FJ, Alvarez-Sabin J, Molina CA: Bridging intravenous-intra-arterial rescue strategy increases recanalization and the likelihood of a good outcome in nonresponder intravenous tissue plasminogen activator-treated patients: a case–control study. Stroke. 2011, 42 (4): 993-997. 10.1161/STROKEAHA.110.597104. published online first: 3 March 2011CrossRefPubMed
5.
go back to reference Mazighi M, Meseguer E, Labreuche J, Amarenco P: Bridging therapy in acute ischemic stroke: a systematic review and meta-analysis. Stroke. 2012, 43 (5): 1302-1308. 10.1161/STROKEAHA.111.635029.CrossRefPubMed Mazighi M, Meseguer E, Labreuche J, Amarenco P: Bridging therapy in acute ischemic stroke: a systematic review and meta-analysis. Stroke. 2012, 43 (5): 1302-1308. 10.1161/STROKEAHA.111.635029.CrossRefPubMed
6.
go back to reference Jeromel M, Milosevic ZV, Kocijancic IJ, Lovric D, Svigelj V, Zvan B: Mechanical revascularization for acute ischemic stroke: a single-center, retrospective analysis. Cardiovasc Intervent Radiol. 2013, 36 (2): 338-345. 10.1007/s00270-012-0441-x. Published online first: 18 July 2012CrossRefPubMed Jeromel M, Milosevic ZV, Kocijancic IJ, Lovric D, Svigelj V, Zvan B: Mechanical revascularization for acute ischemic stroke: a single-center, retrospective analysis. Cardiovasc Intervent Radiol. 2013, 36 (2): 338-345. 10.1007/s00270-012-0441-x. Published online first: 18 July 2012CrossRefPubMed
Metadata
Title
Mechanical thrombectomy – an alternative treatment option in a patient with acute ischemic stroke and multiple contraindications for systemic thrombolysis: a case report
Authors
Katrin Christina Sczesni
Reinhard Wiebringhaus
Lothar Heuser
Sabine Skodda
Jens Eyding
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2013
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-7-256

Other articles of this Issue 1/2013

Journal of Medical Case Reports 1/2013 Go to the issue