A Challenging Case: Endovascular Treatment in a Patient with Large Ischemic Core and Dramatic Recovery

• Published in: Case reports in neurology Vol. 12; no. Suppl 1; pp. 56 - 62
• Main Authors: Nguyen, Trung Quoc, Dang, Tinh Quang, Phan, Hoang Thi, Nguyen, Thang Huy
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.12.2020; Karger Publishers
• Subjects: Acute Ischaemic Stroke – Reperfusion with Thrombectomy and Advanced Multimodal Imaging; Acute Ischaemic Stroke − Reperfusion with Thrombectomy and Advanced Multimodal Imaging; Case reports; challenging case; dramatic recovery; Hemorrhage; Ischemia; large core; Magnetic resonance imaging; Patients; Recovery (Medical); Software; Stroke; thrombectomy; Challenging case; Stroke; Thrombectomy; Large core; Dramatic recovery
• DOI: 10.1159/000506974
• ISSN: 1662-680X

Uncertainty exists over the efficacy and safety of endovascular treatment in patients with large ischemic cores in anterior circulation. Several trials have shown some potential benefits in selected patients despite their late presentation. In particular, perfusion imaging modalities equipped with automatic software has been proven useful in identifying patients with large ischemic cores that are at risk of infarct core expansion, meaning that this specific patient group could still benefit from reperfusion treatment. We reported a case of late-presenting and progressing acute ischemic stroke who was selected by perfusion imaging with RAPID software and successfully underwent endovascular thrombectomy. On admission, her National Institutes of Health Stroke Scale (NIHSS) score was 7. Computed tomography angiography showed complete occlusion of the proximal right middle cerebral artery. Subsequent advanced perfusion imaging with automatic software showed that the ischemic core was 88 mL, T max >6 s volume was 131 mL, and mismatch volume was 43 mL. She was rapidly transferred to the Cath lab for thrombectomy with a stent retriever. Her NIHSS score was 15 before the endovascular procedure. She had a dramatic recovery with an NIHSS score of 4 at 24-h after the procedure. She was discharged on day 9 with a modified Rankin Score of 1. Our findings suggest that endovascular treatment can be beneficial to the patients, particularly younger ones, with large ischemic cores with the aid of perfusion imaging.