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A challenging case: endovascular treatment in a patient with large ischemic core and dramatic recovery


Nguyen, TQ and Dang, TQ and Phan, HT and Nguyen, TH, A challenging case: endovascular treatment in a patient with large ischemic core and dramatic recovery, Case Reports in Neurology, 12, Suppl. 1 pp. 56-62. ISSN 1662-680X (2020) [Refereed Article]

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2020 The Author(s). This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License

DOI: doi:10.1159/000506974


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, Tmax >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.

Item Details

Item Type:Refereed Article
Keywords:stroke, endovascular, challenging case, dramatic recovery, large core, thrombectomy
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Phan, HT (Dr Hoang Phan)
ID Code:142143
Year Published:2020
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-12-15
Last Modified:2022-08-25
Downloads:19 View Download Statistics

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