Case report, case study
https://doi.org/10.21857/mwo1vc3jpy
The reality of a real-world stroke patient – extended time window, low ASPECTS, and a good outcome
Marina Roje Bedeković
; Department of Neurology, Sestre Milosrdnice University Hospital Center, School of Medicine, University of Zagreb
*
Ivona Jerković
; Department of Neurology, Sestre Milosrdnice University Hospital Center
Nataša Milošević
; Department of Neurology, Sestre Milosrdnice University Hospital Center
Luka Miličević
; Department of Neurology, Sestre Milosrdnice University Hospital Center
* Corresponding author.
Abstract
Mechanical thrombectomy (MT) is recommended in patients with anterior large vessel occlusion from 6 to 24 hours after stroke onset in selected patients with baseline ischemia defined by Alberta stroke program early CT score (ASPECTS) ≥ 6. Recent studies have shown that carefully selected patients with lower ASPECTS 3-5 and even with ASPECTS 0-2 could benefit from MT. A 45-year-old patient was admitted to our emergency department 14 hours after the stroke onset. The neurological assessment revealed severe dysarthria, gaze palsy to the right, and severe left arm and leg palsy. His National Institutes of Health Stroke Scale (NIHSS) score was 10. The emergent brain CT scan showed large right middle cerebral artery territory infarction with right internal carotid artery and right M2 segment occlusion on CT angiography. The ASPECTS was 2. CT perfusion showed a good core/penumbra mismatch ratio in temporal/peri-insular parts and basal ganglia. The MT was
performed 14 hours after the stroke onset with a TICI 2b score. The treatment was complicated by the progression of severe brain edema and brain herniation which required emergent decompressive craniectomy. The patient was discharged to the neurorehabilitation center after 26 hospital days with an NIHSS 10. On the last outpatient visit, after three months, the patient scored 5 on NIHHS and 3 on the 3-month Modified Rankin Score. Our patient was successfully treated by MT despite a low ASPECTS and extended time window. Further randomized control trials are necessary to define which subgroup of these patients can benefit from MT.
Keywords
ASPECTS; extended time window; large baseline ischemia; mechanical thrombectomy
Hrčak ID:
312741
URI
Publication date:
22.12.2023.
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