Two mechanical thrombectomies in acute ischemic stroke within 48 hours: A case report on a patient with atrial fibrillation

Abstract

Mechanical thrombectomy is the gold standard in treating acute ischemic stroke complicated by large vessel occlusion. However, there are limited studies on repeated mechanical thrombectomy in acute ischemic stroke. In this case, we report a 68-year-old male with atrial fibrillation who developed sudden left limb weakness and motor aphasia for 6 hours, and his National Institutes of Health Stroke Scale (NIHSS) score was 10. Computed tomography angiography (CTA) showed occlusion of the right internal carotid artery, and mechanical thrombectomy was performed immediately. The patient's neurologic disability was utterly relieved, and the NIHSS score returned to 0. At 30 hours postoperatively, he again developed left limb weakness with motor aphasia. The NHISS Score was 11, and the CTA showed that the right internal carotid artery was re-occluded. After computed tomography perfusion evaluation, the patient underwent mechanical thrombectomy again, and the etiological examination confirmed Cardioembolism. Anticoagulation therapy was commenced 1 week post-thrombectomy. The prognosis of the patients was good.

Keywords: Acute ischemic stroke; Atrial fibrillation; Mechanical thrombectomy; Repeated mechanical thrombectomy.

Fig. 1

The first mechanical thrombectomy, from A–D, showed no low-density lesions on preoperative head CT, occlusion of the right internal carotid artery (arrow), complete recanalization of the blood vessels after surgery, and no internal carotid stenosis.

Fig. 2

The second mechanical thrombectomy, from A–D, suggested a recurrence of right-side internal carotid artery (arrow) occlusion, a mismatch between CT perfusion ischemia and core infarct size, and blood flow was restored again.

Fig. 3

After repeated mechanical thrombectomy, diffusion-weighted imaging (DWI) shows a small infarct area.