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Case Reports
. 2021;15(2):124-128.
doi: 10.5797/jnet.cr.2020-0102. Epub 2020 Sep 16.

Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy: A Case Report

Takuya Moriyama  1 , Yuri Sugiura  1 , Yuto Hayashi  1 , Fukuaki Kinoshita  1 , Ryohei Yamamura  1 , Masayuki Moriya  1 , Chikao Tatsumi  1 , Masaru Yokoe  1 , Kazuyuki Nagatsuka  1 , Masahiro Ishihara  2 , Tetsu Goto  2 , Masami Nishio  2 , Yuko Watanabe  3
Affiliations
Case Reports

Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy: A Case Report

Takuya Moriyama et al. J Neuroendovasc Ther. 2021.

Abstract

Objective: Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) are effective treatments for acute ischemic stroke (AIS). However, the treatment for AIS in pregnancy is not established because no clinical trials have included pregnant patients. We present a case of middle cerebral artery (MCA) M2 segment occlusion in pregnancy treated with IV thrombolysis and endovascular therapy.

Case presentation: A 36-year-old woman being 6 weeks pregnant presented with right-sided hemiparesis and aphasia. MRI showed a high-intensity area on diffusion-weighted imaging of the left parietal lobe, and MRA showed left MCA M2 segment occlusion. She underwent IV rt-PA and MT and achieved thrombolysis in cerebral infarction 2b revascularization without complications. The protein S concentration was lower than that in the physiological changes during pregnancy. She was diagnosed with embolic stroke related to coagulopathy in pregnancy, and she underwent anticoagulation. At the 3-month follow-up, the modified Rankin Scale was 0. She miscarried at 4 months, and the fetal death was presumed to be obstetric cause.

Conclusion: IV rt-PA and MT may be effective and safe treatments for pregnant patients. Estimated fetal radiation exposure during MT is low and is presumed not to affect fetal development. We should mitigate the radiation dose and reduce the dose of iodinated contrast agents, particularly in pregnant patients.

Keywords: ischemic stroke; mechanical thrombectomy; pregnancy; thrombolysis.

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Conflict of interest statement

The authors have no conflicts of interest directly relevant to the content of this report.

Figures

Fig. 1
Fig. 1. (A) Diffusion-weighted imaging revealed a high intensity area of the left parietal lobe. (B) Hyperintensity vessel sign was positive on FLAIR (white arrow). (C) Susceptibility vessel sign was positive on T2*-weighted imaging (black arrow). (D) MRA revealed left MCA M2 segment occlusion (white arrow). MCA: middle cerebral artery
Fig. 2
Fig. 2. (A) Left internal carotid artery angiography demonstrated occlusion of the left MCA M2 segment (black arrow). (B) Trevo 3 mm × 20 mm was deployed in the left MCA M2 segment. Black arrow shows the distal tip of the Trevo. (C) After first pass, angiography showed the inferior trunk recanalization and the superior trunk occlusion with the migrated thrombus (black arrow). (D) Post-thrombectomy angiography showed recanalization of the left M2 segment. MCA: middle cerebral artery
See this image and copyright information in PMC

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References

    1. Yoshida K, Takahashi JC, Takenobu Y, et al. : Strokes associated with pregnancy and puerperium: a nationwide study by the Japan Stroke Society. Stroke 2017; 48: 276–282. - PubMed
    1. Terón I, Eng MS, Katz JM: Causes and treatment of acute ischemic stroke during pregnancy. Curr Treat Options Neurol 2018; 20: 21. - PubMed
    1. Toyoda K, Koga M, Iguchi Y, et al. : Guidelines for intravenous thrombolysis (recombinant tissue-type plasminogen activator), the third edition, March 2019: a guideline from the Japan Stroke Society. Neurol Med Chir (Tokyo) 2019; 59: 449–491. - PMC - PubMed
    1. Watanabe TT, Ichijo M, Kamata T: Uneventful pregnancy and delivery after thrombolysis plus thrombectomy for acute ischemic stroke: case study and literature review. J Stroke Cerebrovasc Dis 2019; 28: 70–75. - PubMed
    1. Yamaguchi Y, Kondo T, Ihara M, et al. : Intravenous recombinant tissue plasminogen activator in an 18-week pregnant woman with embolic stroke. Clin Neurol 2010; 50: 315–319. - PubMed

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