Surgical thrombectomy after large vessel ischaemic stroke – a case report

Detalhes bibliográficos
Autor(a) principal: Peixoto, João
Data de Publicação: 2023
Outros Autores: Brandão, Pedro, Coelho, Andreia, Fernandes, Luís, Machado, Marta, Basílio, Francisco, Canedo, Alexandra
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.48750/acv.541
Resumo: BACKGROUND: Endovascular mechanical thrombectomy (MT) changed acute ischaemic stroke management and is considered the standard of care for patients with proximal anterior circulation occlusion. MT improves functional independence, without an increase in mortality. Despite its advantages, up to 20% of patients treated with MT do not have successful recanalization, leading to poor clinical outcome. We present a case of an acute ischaemic stroke of the anterior circulation due to occlusion of the common carotid artery successfully submitted to surgical thrombectomy after failed MT. CASE REPORT: A 43-year-old male, with prior history of diabetes, hypertension, dyslipidaemia and heart failure was admitted at the emergency unit with acute bilateral lower limb ischaemia, due to cardioembolic phenomena. He was submitted to bilateral femoral thrombectomy and started endovenous unfractionated heparin. On the fifth postoperative day he developed sudden depression of cognitive status and left side hemiplegia of brachial predominance. Computed tomography angiography revealed an occlusion of brachiocephalic trunk, right subclavian artery and common carotid artery, preserving its branches. MT, performed by interventional neuroradiology, was unsuccessful (no recanalization or clinical improvement). After multidisciplinary discussion, the patient underwent urgent surgical thrombectomy through carotid and transaxillary approaches. Postoperatively, the patient’s mental status and left sided motor function recovered progressively over time. Three months after, patient maintains anticoagulation with warfarin, without neurological sequalae. CONCLUSION: The low rate of recanalization and poor clinical outcome after MT failure underlines the need for alternative rescue approaches. Surgical thrombectomy could represent a lifeline. More studies are needed to corroborate its efficacy in patients with anterior circulation acute ischaemic stroke.
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spelling Surgical thrombectomy after large vessel ischaemic stroke – a case reportSurgical thrombectomyAcute ischaemic strokethrombolysis in cerebral infarctionstent-retrievercommon carotid arteryBACKGROUND: Endovascular mechanical thrombectomy (MT) changed acute ischaemic stroke management and is considered the standard of care for patients with proximal anterior circulation occlusion. MT improves functional independence, without an increase in mortality. Despite its advantages, up to 20% of patients treated with MT do not have successful recanalization, leading to poor clinical outcome. We present a case of an acute ischaemic stroke of the anterior circulation due to occlusion of the common carotid artery successfully submitted to surgical thrombectomy after failed MT. CASE REPORT: A 43-year-old male, with prior history of diabetes, hypertension, dyslipidaemia and heart failure was admitted at the emergency unit with acute bilateral lower limb ischaemia, due to cardioembolic phenomena. He was submitted to bilateral femoral thrombectomy and started endovenous unfractionated heparin. On the fifth postoperative day he developed sudden depression of cognitive status and left side hemiplegia of brachial predominance. Computed tomography angiography revealed an occlusion of brachiocephalic trunk, right subclavian artery and common carotid artery, preserving its branches. MT, performed by interventional neuroradiology, was unsuccessful (no recanalization or clinical improvement). After multidisciplinary discussion, the patient underwent urgent surgical thrombectomy through carotid and transaxillary approaches. Postoperatively, the patient’s mental status and left sided motor function recovered progressively over time. Three months after, patient maintains anticoagulation with warfarin, without neurological sequalae. CONCLUSION: The low rate of recanalization and poor clinical outcome after MT failure underlines the need for alternative rescue approaches. Surgical thrombectomy could represent a lifeline. More studies are needed to corroborate its efficacy in patients with anterior circulation acute ischaemic stroke.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2023-11-26info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.541https://doi.org/10.48750/acv.541Angiologia e Cirurgia Vascular; Vol. 19 No. 3 (2023): September; 198-200Angiologia e Cirurgia Vascular; Vol. 19 N.º 3 (2023): Setembro; 198-2002183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/541http://acvjournal.com/index.php/acv/article/view/541/356Copyright (c) 2023 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessPeixoto, JoãoBrandão, PedroCoelho, AndreiaFernandes, LuísMachado, MartaBasílio, FranciscoCanedo, Alexandra2023-12-01T10:30:19Zoai:ojs.acvjournal.com:article/541Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T00:40:28.589685Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Surgical thrombectomy after large vessel ischaemic stroke – a case report
title Surgical thrombectomy after large vessel ischaemic stroke – a case report
spellingShingle Surgical thrombectomy after large vessel ischaemic stroke – a case report
Peixoto, João
Surgical thrombectomy
Acute ischaemic stroke
thrombolysis in cerebral infarction
stent-retriever
common carotid artery
title_short Surgical thrombectomy after large vessel ischaemic stroke – a case report
title_full Surgical thrombectomy after large vessel ischaemic stroke – a case report
title_fullStr Surgical thrombectomy after large vessel ischaemic stroke – a case report
title_full_unstemmed Surgical thrombectomy after large vessel ischaemic stroke – a case report
title_sort Surgical thrombectomy after large vessel ischaemic stroke – a case report
author Peixoto, João
author_facet Peixoto, João
Brandão, Pedro
Coelho, Andreia
Fernandes, Luís
Machado, Marta
Basílio, Francisco
Canedo, Alexandra
author_role author
author2 Brandão, Pedro
Coelho, Andreia
Fernandes, Luís
Machado, Marta
Basílio, Francisco
Canedo, Alexandra
author2_role author
author
author
author
author
author
dc.contributor.author.fl_str_mv Peixoto, João
Brandão, Pedro
Coelho, Andreia
Fernandes, Luís
Machado, Marta
Basílio, Francisco
Canedo, Alexandra
dc.subject.por.fl_str_mv Surgical thrombectomy
Acute ischaemic stroke
thrombolysis in cerebral infarction
stent-retriever
common carotid artery
topic Surgical thrombectomy
Acute ischaemic stroke
thrombolysis in cerebral infarction
stent-retriever
common carotid artery
description BACKGROUND: Endovascular mechanical thrombectomy (MT) changed acute ischaemic stroke management and is considered the standard of care for patients with proximal anterior circulation occlusion. MT improves functional independence, without an increase in mortality. Despite its advantages, up to 20% of patients treated with MT do not have successful recanalization, leading to poor clinical outcome. We present a case of an acute ischaemic stroke of the anterior circulation due to occlusion of the common carotid artery successfully submitted to surgical thrombectomy after failed MT. CASE REPORT: A 43-year-old male, with prior history of diabetes, hypertension, dyslipidaemia and heart failure was admitted at the emergency unit with acute bilateral lower limb ischaemia, due to cardioembolic phenomena. He was submitted to bilateral femoral thrombectomy and started endovenous unfractionated heparin. On the fifth postoperative day he developed sudden depression of cognitive status and left side hemiplegia of brachial predominance. Computed tomography angiography revealed an occlusion of brachiocephalic trunk, right subclavian artery and common carotid artery, preserving its branches. MT, performed by interventional neuroradiology, was unsuccessful (no recanalization or clinical improvement). After multidisciplinary discussion, the patient underwent urgent surgical thrombectomy through carotid and transaxillary approaches. Postoperatively, the patient’s mental status and left sided motor function recovered progressively over time. Three months after, patient maintains anticoagulation with warfarin, without neurological sequalae. CONCLUSION: The low rate of recanalization and poor clinical outcome after MT failure underlines the need for alternative rescue approaches. Surgical thrombectomy could represent a lifeline. More studies are needed to corroborate its efficacy in patients with anterior circulation acute ischaemic stroke.
publishDate 2023
dc.date.none.fl_str_mv 2023-11-26
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://doi.org/10.48750/acv.541
https://doi.org/10.48750/acv.541
url https://doi.org/10.48750/acv.541
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv http://acvjournal.com/index.php/acv/article/view/541
http://acvjournal.com/index.php/acv/article/view/541/356
dc.rights.driver.fl_str_mv Copyright (c) 2023 Angiologia e Cirurgia Vascular
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2023 Angiologia e Cirurgia Vascular
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
dc.source.none.fl_str_mv Angiologia e Cirurgia Vascular; Vol. 19 No. 3 (2023): September; 198-200
Angiologia e Cirurgia Vascular; Vol. 19 N.º 3 (2023): Setembro; 198-200
2183-0096
1646-706X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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