Endovascular mechanical thrombectomy of an occluded superior division branch of the left MCA for acute cardioembolic stroke

Cardiovasc Intervent Radiol. May-Jun 2003;26(3):305-8. doi: 10.1007/s00270-003-2719-5.

Abstract

Cardiac embolism accounts for a large proportion of ischemic stroke. Revascularization using systemic or intra-arterial thrombolysis is associated with increasing risks of cerebral hemorrhage as time passes from stroke onset. We report successful mechanical thrombectomy from a distal branch of the middle cerebral artery (MCA) using a novel technique. A 72-year old man suffered an acute ischemic stroke from an echocardiographically proven ventricular thrombus due to a recent myocardial infarction. Intraarterial administration of 4 mg rt-PA initiated at 5.7 hours post-ictus failed to recanalize an occluded superior division branch of the left MCA. At 6 hours, symptomatic embolic occlusion persisted. Mechanical extraction of the clot using an Attracter-18 device (Target Therapeutics, Freemont, CA) resulted in immediate recanalization of the MCA branch. Attracter-18 for acute occlusion of MCA branches may be considered in selected patients who fail conventional thrombolysis or are nearing closure of the therapeutic window for use of thrombolytic agents.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Brain Ischemia / diagnosis
  • Brain Ischemia / etiology
  • Brain Ischemia / therapy
  • Echocardiography
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis
  • Infarction, Middle Cerebral Artery / etiology
  • Infarction, Middle Cerebral Artery / therapy*
  • Male
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / pathology
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis
  • Thrombectomy*
  • Tissue Plasminogen Activator / therapeutic use
  • Tomography, X-Ray Computed

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator