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Perfusion-based decision making for mechanical thrombectomy in a Transient Ischemic Attack patient with middle cerebral artery occlusion
Citation
Nguyen, TH and Pham, BN and Phan, HT and Nguyen, TQ and Phan, BV, Perfusion-based decision making for mechanical thrombectomy in a Transient Ischemic Attack patient with middle cerebral artery occlusion, Case Reports in Neurology, 12, Suppl. 1 pp. 41-48. ISSN 1662-680X (2020) [Refereed Article]
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Copyright Statement
© 2020 The Author(s). This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) https://creativecommons.org/licenses/by-nc/4.0/
Abstract
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.
Item Details
Item Type: | Refereed Article |
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Keywords: | thrombectomy, endovascular treatment, recurrent stroke, acute ischemic stroke, mechanical thrombectomy, transient ischemic attack, minor stroke, large-vessel occlusion |
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: | 142146 |
Year Published: | 2020 |
Web of Science® Times Cited: | 1 |
Deposited By: | Menzies Institute for Medical Research |
Deposited On: | 2020-12-15 |
Last Modified: | 2021-03-30 |
Downloads: | 10 View Download Statistics |
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