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Double stent retriever mechanical thrombectomy of refractory right MCA bifurcation thrombus in a patient who previously had left MCA infarct

Last update on May 23, 2022

Find out how Ahmet Gunkan, Eyup Kizil and Yilmaz Onal treated a 60-year-old female patient! 

 

Case

PATIENT 

  • 60 YO female
  • Hypertension
  • Cardiomegali
  • Atrial fibrillation for 12 years
  • Antihypertensif medication and 20 mg rivaroxaban daily
  • L-Mca infarct 11 years ago, weakness of the right upper extremity

CT AND MRI FROM 2015

  • Had physical therapy for a few years
  • Able to carry out usual activities despite the weakness of the right upper extremity
  • mRS score: 1

 

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0:30 AM

Last well seen by relatives

03:00 AM

  • Fall on the ground while trying to get up
  • Mutism
  • Her relatives called emergency and team arrived around 30 mins

 

04:00 AM

  • Time to arrive at the hospital
  • Left hemiparesis
  • Aphasia , NIHSS:12

 

04:30 AM

  • Time for CT/CTA  hospital

 

Unknown onset and rivaroxaban

  • iv-tPA not given
  • Patient agitated
  • Transferred to neuro-interventional unit after CT and intubated before the thrombectomy

 

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Aspect score : 9

 

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06:00 AM 

  • Groin puncture
  • 8F Balloon guiding catheter -95 cm
  • 0.021″ micro-catheter
  • 0.014 ″ microwire 6x40 mm stent retriever (Catchvmax)
  • Other competitive devices : Solitaire ,Trevo
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  • Single stent retriever thrombectomy failed 3x

 

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  • Both of the R-mca trunks catheterized

 

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  • Deployment of the stent-retrievers

 

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  • Simultaneous retrieval of both stents

 

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06:45 AM

 

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CT AT 24 HOURS

  • No infarct
  • No hemorrhage

NIHSS:2 at discharge

  • Antiplatelet and anticoagulation

At 1-month and 3-month mRS score: 1

 

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