scholarly journals Successful Mechanical Thrombectomy of Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset

2021 ◽  
Vol 3 (01) ◽  
pp. 42-44
Author(s):  
Robin Bhattarai ◽  
Karuna Tamrakar Karki ◽  
Dinesh Kumar Thapa ◽  
Navin Kumar Yadav
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Stroke Onset ◽  
Therapeutic Window ◽  
Left Middle Cerebral Artery ◽  
Significant Past Medical History ◽  
Endovascular Thrombectomy ◽  
Cerebral Artery Occlusion

A 45-year-old patient with no significant past medical history presented to out-patient department with aphasia and right hand weakness with a National Institutes of Health Stroke Scale (NIHSS) of 10 and occlusion of the left middle cerebral artery (MCA) in the M1 segment. Last known normal time was 14hrs (wake up stroke). Immediate endovascular thrombectomy was performed 14 hours after symptom onset with complete recanalization and complete clinical recovery. Although mechanical thrombectomy is generally considered an effective alternative strategy up to 8 hours after stroke onset, selected patients with a large diffusion/perfusion mismatch and small infarct cores may benefit from an expanded therapeutic window.

scholarly journals Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Anelia Dietmann ◽  
Kety Wha-Vei Hsieh ◽  
Andrea M. Humm ◽  
Claudio L. Bassetti ◽  
Urs Fischer ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Symptom Onset ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Stroke Onset ◽  
Neurological Deficits ◽  
Therapeutic Window ◽  
Left Middle Cerebral Artery ◽  
Large Diffusion

A 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological deficits no IVT was performed. Nine hours after symptom onset the patient gradually deteriorated with a NIHSS fluctuating between 9 and 15. MRI showed a persistent occlusion of the MCA with a large diffusion-perfusion mismatch. Immediate endovascular thrombectomy was performed 14 hours after symptom onset with complete recanalization and complete clinical recovery. Although mechanical thrombectomy is generally considered an effective alternative strategy up to 8 hours after stroke onset, selected patients with a large diffusion/perfusion mismatch and small infarct cores may benefit from an expanded therapeutic window.

scholarly journals Early Thrombectomy of a Proximal Middle Cerebral Artery Occlusion Leading to Complete Recovery with No Infarct

2017 ◽  
Vol 9 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Sverre Myren-Svelstad ◽  
Tommy A. Hammer ◽  
Titto T. Idicula
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Sudden Onset ◽  
Left Middle Cerebral Artery ◽  
Excellent Outcome ◽  
Proximal Middle Cerebral Artery ◽  
Cerebral Artery Occlusion

Many recent trials show the benefit of mechanical thrombectomy in acute ischemic stroke caused by thrombi lodged in large arteries. We report the case of a 55-year-old patient who developed sudden-onset right-sided hemiplegia and aphasia. Computed tomography angiography showed a thrombus in the M1 segment of the left middle cerebral artery. The thrombus was removed by mechanical thrombectomy 85 min after the onset of symptoms. A magnetic resonance imaging (MRI) scan showed no infarct, and the patient was discharged symptom free. To the best of our knowledge, this is the first report of thrombectomy of a symptomatic proximal middle cerebral artery occlusion leading to complete rescue, both clinically and radiologically assessed by MRI. Our case report shows that an early thrombectomy can provide an excellent outcome.

scholarly journals Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study

2020 ◽  
pp. neurintsurg-2020-016427
Author(s):  
Adam de Havenon ◽  
Ana Paula Narata ◽  
Aymeric Amelot ◽  
Jeffrey L Saver ◽  
Hormozd Bozorgchami ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Scale Score ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Endovascular Thrombectomy ◽  
Good Outcome ◽  
Cerebral Artery Occlusion

BackgroundThe benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population.ObjectiveTo compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial.MethodsWe performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0–2, which we termed good outcome. Secondary outcomes included reperfusion rates and major adverse events. The primary predictor was M2 occlusion, which we compared with M1 occlusion.ResultsWe included 183 patients, of whom 126 (69%) had M1 occlusion and 57 (31%) had M2 occlusion. There was no difference in the reperfusion rates or adverse events between M2 and M1 occlusions. The rate of good outcome was not different in M2 versus M1 occlusions (70.2% vs 69.7%, p=0.946). In a logistic regression model adjusted for age, sex, and baseline National Institutes of Health Stroke Scale score, M2 occlusions did not have a significantly different odds of good outcome compared with M1 occlusions (OR 0.94, 95% CI 0.47 to 1.88, p=0.87).ConclusionIn ARISE II, M2 occlusions achieved a 70.2% rate of good outcome at 90 days, which is above published rates for untreated M2 occlusions and superior to prior reports of M2 occlusions treated with endovascular thrombectomy. We also report similar rates of good outcome, successful reperfusion, death, and other adverse events when comparing the M1 and M2 occlusions.

GABAergic contribution to rat bladder hyperactivity after middle cerebral artery occlusion

2000 ◽  
Vol 279 (4) ◽  
pp. R1230-R1238 ◽  
Author(s):  
Sayoko Kanie ◽  
Osamu Yokoyama ◽  
Kazuto Komatsu ◽  
Koichi Kodama ◽  
Satoshi Yotsuyanagi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Receptor Agonist ◽  
Bladder Capacity ◽  
Artery Occlusion ◽  
Female Rats ◽  
Left Middle Cerebral Artery ◽  
Urethral Pressure ◽  
Cerebral Artery Occlusion

To evaluate the influences of γ-aminobutyric acid (GABA) mechanisms on bladder hyperactivity after left middle cerebral artery occlusion, cystometric recordings were obtained from unanesthetized female rats. Intracerebroventricular administration of both muscimol (GABAA receptor agonist; 0.1–10 nmol) and baclofen (GABAB receptor agonist; 0.1–3 nmol) produced dose-dependent inhibitions of micturition with increases in bladder capacity (BC). The effects of high doses (1–10 nmol) were similar in sham-operated (SO) and cerebral-infarcted (CI) rats. However, lower doses of muscimol (0.1 or 0.3 nmol) and baclofen (0.1 nmol) reduced BC in CI rats. After bicuculline (GABAA receptor antagonist; 1 or 3 nmol) administration, BC in both SO and CI rats first decreased and subsequently increased. An increase in urethral pressure was observed after administration of bicuculline (3 nmol) but not with either muscimol or baclofen. Infarct volumes in muscimol-, bicuculline-, or baclofen-treated rats were not significantly different from those of vehicle-treated rats. These results suggest that GABAergic mechanisms inhibit the micturition reflex at the supraspinal level but that this can change as a result of CI.

Demonstration of therapeutic window of Cerebrolysin in embolic stroke: A prospective, randomized, blinded, and placebo-controlled study

2017 ◽  
Vol 12 (6) ◽  
pp. 628-635 ◽  
Author(s):  
Li Zhang ◽  
Michael Chopp ◽  
Mei Lu ◽  
Talan Zhang ◽  
Chao Li ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Mean Difference ◽  
Embolic Stroke ◽  
Therapeutic Window ◽  
Cerebral Artery Occlusion

Background and aims In an effort to characterize the effects of Cerebrolysin for treatment of stroke that are essential for successful clinical translation, we have demonstrated that Cerebrolysin dose dependently enhanced neurological functional recovery in experimental stroke. Here, we conduct a prospective, randomized, placebo-controlled, blinded study to examine the therapeutic window of Cerebrolysin treatment of rats subjected to embolic stroke. Methods Male Wistar rats age 3–4 months (n = 100) were subjected to embolic middle cerebral artery occlusion. Animals were randomized to receive saline or Cerebrolysin daily for 10 consecutive days starting 4, 24, 48, and 72 h after middle cerebral artery occlusion. Neurological outcome was measured weekly with a battery of behavioral tests (adhesive removal test, modified neurological severity score (mNSS), and foot-fault test). Global test was employed to assess Cerebrolysin effect on neurological recovery with estimation of mean difference between Cerebrolysin and control-treated groups and its 95% confidence interval in the intent-to-treat population, where a negative value of the mean difference and 95% confidence interval < 0 indicated a significant treatment effect. All rats were sacrificed 28 days after middle cerebral artery occlusion and infarct volume was measured. Results Cerebrolysin treatment initiated within 48 h after middle cerebral artery occlusion onset significantly improved functional outcome; mean differences and 95% confidence interval were −11.6 (−17.7, −5.4) at 4 h, −7.1 (−13.5, −0.8) at 24 h, −8.4 (−14.2, −8.6) at 48 h, and −4.9 (−11.4, 1.5) at 72 h. There were no differences on infarct volume and mortality rate among groups. Conclusions With a clinically relevant rigorous experimental design, our data demonstrate that Cerebrolysin treatment effectively improves stroke recovery when administered up to 48 h after middle cerebral artery occlusion.

scholarly journals Brain Cleanup as a Potential Target for Poststroke Recovery

Stroke ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 958-966 ◽  
Author(s):  
Shun-Ming Ting ◽  
Xiurong Zhao ◽  
Guanghua Sun ◽  
Lidiya Obertas ◽  
Mercedes Ricote ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Functional Recovery ◽  
Artery Occlusion ◽  
Therapeutic Window ◽  
Peroxisome Proliferator ◽  
Phagocytic Cells ◽  
Peroxisome Proliferator Activated Receptor ◽  
Cerebral Artery Occlusion

Background and Purpose— Phagocytic cells, such as microglia and blood-derived macrophages, are a key biological modality responsible for phagocytosis-mediated clearance of damaged, dead, or displaced cells that are compromised during senescence or pathological processes, including after stroke. This process of clearance is essential to eliminate the source of inflammation and to allow for optimal brain repair and functional recovery. Transcription factor, RXR (retinoic-X-receptor) is strongly implicated in phagocytic functions regulation, and as such could represent a novel target for brain recovery after stroke. Methods— Primary cultured microglia and bone marrow macrophages were used for phagocytic study. Mice with deleted RXR-α in myeloid phagocytes (Mac-RXR-α −/− ) were subjected to transient middle cerebral artery occlusion to mimic ischemic stroke and then treated with RXR agonist bexarotene. RNA-sequencing and long-term recovery were evaluated. Results— Using cultured microglia, we demonstrated that the RXR-α promotes the phagocytic functions of microglia toward apoptotic neurons. Using mice with deleted RXR-α in myeloid phagocytes (Mac-RXR-α −/− ), we have shown that despite behaving similarly to the control at early time points (up to 3 days, damage established histologically and behaviorally), these Mac-RXR-α −/− mice demonstrated worsened late functional recovery and developed brain atrophy that was larger in size than that seen in control mice. The RXR-α deficiency was associated with reduced expression of genes known to be under control of the prominent transcriptional RXR partner, PPAR (peroxisome proliferator-activated receptor)-γ, as well as genes encoding for scavenger receptors and genes that signify microglia/macrophages polarization to a reparative phenotype. Finally, we demonstrated that the RXR agonist, bexarotene, administered as late as 1 day after middle cerebral artery occlusion, improved neurological recovery, and reduced the atrophy volume as assessed 28 days after stroke. Bexarotene did not improve outcome in Mac-RXR-α −/− mice. Conclusions— Altogether, these data suggest that phagocytic cells control poststroke recovery and that RXR in these cells represents an attractive target with exceptionally long therapeutic window.

Successful double mechanical thrombectomy in bilateral M1 middle cerebral artery occlusion

2019 ◽  
Vol 120 (1) ◽  
pp. 211-213 ◽  
Author(s):  
Delphine London ◽  
Frédéric London ◽  
Yves Vandermeeren ◽  
Fabrice C. Deprez
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Cerebral Artery Occlusion
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