Treatment of acute ischemic stroke by systemic thrombolysis combined with endovascular thrombectomy: case report

Abstract

Background: A small number of acute ischemic stroke (AIS) patients meets eligibility criteria for systemic thrombolysis (ST) with recombinant tissue plasminogen activator, but its efficacy for large vessel occlusion is poor. Therefore, an increasing number of patients with large-vessel stroke are treated with endovascular mechanical thrombectomy (EMT). Material and methods: We describe consequent events of our clinic’s patient with AIS who underwent endovascular thrombectomy combined with thrombolytic therapy after conventional imaging – a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA). Results: A 51-year-old man was admitted in our clinic with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 22 on presentation and his brain NCCT showed left MCA M1 hyperdensity and Alberta Stroke Programme Early CT Score (ASPECTS) of 9. ST was initiated with door-needle time of 40 min and was ineffective. His CTA confirmed a left MCA distal M1 occlusion. Afterwards he successfully underwent thrombectomy, with a door-to-groin-puncture time of 120 min. His NIHSS score improved to 8 over the next 24 hours and he was discharged with NIHSS 4. Conclusions: EMT seems to be a perfect option for patients with large-vessel stroke who did not benefit from ST. The presented case confirmed that early presentation and combined treatment with ST and EMT could be lifesaving options for patients with large-vessel stroke.