University of Tasmania
Browse
142144-Perfusion-based decision-making for mechanical thrombectomy in a transient ischemic attack patient with middle cerebral artery occlusion.pdf (462.67 kB)

Perfusion-based decision-making for mechanical thrombectomy in a transient ischemic attack patient with middle cerebral artery occlusion

Download (462.67 kB)
journal contribution
posted on 2023-05-20, 19:54 authored by Nguyen, TH, Pham, BN, Hoang PhanHoang Phan, Nguyen, TQ, Phan, BV
A significant proportion of patients with large-vessel occlusion (LVO) initially present to the hospital with transient ischemic attack (TIA) and mild clinical manifestations such as low National Institutes of Health Stroke Scale (NIHSS) scores (≤5). However, due to the natural course of the disease, the individuals may subsequently develop worsening symptoms. To date, there is lack of evidence-based guidelines on mechanical thrombectomy (MT) among those patients. Therefore, the predicting factors associated with better or worse outcomes for acute stroke patients receiving MT compared to those not receiving the treatment are unknown. We describe a TIA case with LVO who was treated with MT; we used perfusion imaging as a decision aid. A 55-year-old male patient with a past medical history of TIA, hypertension, and hyperlipidemia was admitted to our hospital for evaluation of transient mild right hemiparesis and dysarthria lasting for 5 min 3 h before admission. He reported that he had experienced the same condition 1 day before. On admission, neurological examination showed normal function with an NIHSS score of 0. Computed tomography angiography revealed left proximal M1 occlusion. In addition, perfusion magnetic resonance imaging maps calculated by the RAPID software showed acute small lesions on the left hemisphere with core volume (0 mL) and a large ischemic penumbra (70 mL). Immediate endovascular thrombectomy was performed 5 h following symptom onset with complete recanalization and clinical recovery. The case suggests that MT in LVO patients with low NIHSS scores, even a score of 0, on presentation is potentially a safe and effective treatment. The use of perfusion imaging in the acute phase of stroke should be encouraged for the decision-making process.

History

Publication title

Case Reports in Neurology

Volume

12, Suppl. 1

Pagination

41-48

ISSN

1662-680X

Department/School

Menzies Institute for Medical Research

Publisher

S. Karger AG

Place of publication

Switzerland

Rights statement

© 2020 The Author(s). This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License https://creativecommons.org/licenses/by/4.0/

Repository Status

  • Open

Socio-economic Objectives

Treatment of human diseases and conditions

Usage metrics

    University Of Tasmania

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC