Emergency thrombectomy for cerebrovascular occlusion in a patient with mirror-image dextrocardia: a case report

Cases of patients complicated with dextrocardia who suffer from acute cerebral infarction with large vessel occlusion and receive emergency thrombectomy are particularly rare and have not been widely reported. This article aimed to increase the awareness and knowledge of these cases. We report the case of a patient with mirror-image dextrocardia who suffered from cerebral infarction with large vessel occlusion and received emergency thrombectomy. A male patient in his early 60s with dextrocardia had acute cerebral infarction with posterior circulation large vessel occlusion and underwent emergency thrombectomy. During the operation, the rapid confirmation of dextrocardia and use of flexible interventional instruments helped establish a pathway for blood flow. We used an intracranial thrombectomy stent and intracranial balloon dilation catheter to restore the cerebral blood supply. The Modified Rankin Scale score was 0 at 3 months after thrombectomy, indicating a good prognosis of the patient. Acute cerebral infarction with large vessel occlusion in patients with dextrocardia is extremely rare. Emergency thrombectomy is feasible to recanalize cerebral blood flow and give patients a chance to recover.

What to do about fibrin rich ‘tough clots’? Comparing the Solitaire stent retriever with a novel geometric clot extractor in an in vitro stroke model

BackgroundDespite advances in revascularization tools for large vessel occlusion presenting as acute ischemic stroke, a significant subset of clots remain recalcitrant to current strategies. We assessed the effectiveness of a novel thrombectomy device that was specifically designed to retrieve resistant fibrin rich clots, the geometric clot extractor (GCE; Neuravi, Galway, Ireland), in an in vitro cerebrovascular occlusion stroke model.MethodsAfter introducing fibrin rich clot analogues into the middle cerebral artery of the model, we compared the rates of recanalization between GCE and Solitaire flow restoration stent retriever (SR; Medtronic, Minneapolis, Minnesota, USA; control group) cases. A maximum of three passes of each device was allowed. If the SR failed to recanalize the vessel after three passes, one pass of the GCE was allowed (rescue cases).ResultsIn a total of 26 thrombectomy cases (13 GCE, 13 SR), successful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was achieved 100% of the time in the GCE cases with an average of 2.13 passes per case. This rate was significantly higher compared with the Solitaire recanalization rate (7.7%, P<0.0001) with an average of three passes per case. After SR failure (in 92% of cases), successful one pass GCE rescue recanalization was achieved 66% of the time (P<0.005).ConclusionApplication of the GCE in this experimental stroke model to retrieve typically recalcitrant fibrin rich clots resulted in higher successful recanalization rates than the SR.

Diseksi Aorta Ascendens Tipe Stanford A dengan Hemiparese Kiri

Aortic dissection typically presents with chest pain and sometimes can lead into various complication, such as neurological manifestation. The symptoms occur because of cerebrovascular occlusion or general hypotension. The purpose of this case report is to report Stanford type A ascending aortic dissection with left-sided hemiparesis case.We report a case of 72 years-old female admitted to emergency department with left-sided weakness. Patient complained about a chest pain and headache since 3 days before entering into hospital. When resting at home, she felt sudden weakness in her left-sided limb. Chest x-ray showed widening mediastinum with calcifcation suspected as mediastinum mass. Head CT showedcalcifcation in the bilateral of basal ganglia and infarction of right external capsule. Chest CT showed Stanford type A ascending aortic dissection with intraluminal thrombus in inferoposterior of ascending aorta. The fnal diagnosis was Stanford type A ascending aortic dissection accompanied with intracranial hemorrhage and cerebral infarction as neurological manifestations

Tick tock

Ischemic stroke causes morbidity and death in 55 000 Canadians each year. While acute supportive therapy is essential for stabilizing ischemic stroke patients, resolution of cerebrovascular occlusion can only be accomplished by injection of thrombolytic agents. However, older guidelines restrict thrombolysis to within the first 3 hours of symptom onset. This short window of opportunity for thrombolytic treatment is complicated by its inherent adverse reactions, making it necessary to readily identify potential stroke cases, but also to diagnose accurately to avoid inappropriate treatment. In light of statistics that identify late presentation as the most common reason for stroke patients not to receive thrombolytic treatment, and meta-analyses that now show benefits of thrombolytic treatment up to 6 hours after stroke onset, guidelines are undergoing revision to allow larger treatment windows. This, along with continuing improvements in stroke treatment access and infrastructure, will hopefully lead to better outlooks for Canadians who suffer ischemic stroke.