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

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

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

Aspect score : 9

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

• Single stent retriever thrombectomy failed 3x

• Both of the R-mca trunks catheterized

• Deployment of the stent-retrievers

• Simultaneous retrieval of both stents

06:45 AM

CT AT 24 HOURS

• No infarct
• No hemorrhage

NIHSS:2 at discharge

• Antiplatelet and anticoagulation

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