Clinical Presentation
A 38 year old female who was previously well and independent; presented to Royal Stoke University Hospital at 17:00hrs with a suspected stroke 2 Hours after onset of symptoms. The stroke team met the patient at the door and immediate examination revealed an NIHSS 15.
The patient had developed sudden onset left sided hemiparesis together with some dysarthria and inattention. Upon arrival she had a CT of her brain which showed no evidence of acute ischemia and angiography confirmed right mid right M1 occlusion. Perfusion scan showed she had a very small core with a large penumbra and thus she was taken for mechanical thrombectomy.
She was also known to have a familial hypo-fibrinogenemia which despite the presumed propensity for bleeding is known to cause thrombosis in some patients and was probably a contributing factor to her stroke. Based on this there was contraindicated for IV thrombolysis.
Dr Nayak and his team proceeded to the Angiogsuite at 18:00 to perform a Mechanical Thrombectomy which was achieved in 18 mins with a single pass.
Dr Nayak performed the case with:
- Medtronic React™ 71 Aspiration Catheter
- Medtronic Phenom™ 21
- Medtronic 6 X 40 Solitaire™ X revascularisation device
- Penumbra 90 cm 088 Neuron max
Angiogram images
Right MCA Occlusion
AP view showing a triaxial approach
using Neuro Max the React™ 71
aspiration catheter and the
Phenom™ 21 microcatheter
AP view of the ICA and MCA showing the SOLITAIRE-X 6mm x 40mm in situ
AP view of the ICA and MCA cerebral vessels. The patient resulted in an excellent revascularisation with TICI 3
PATIENT OUTCOME
Her NIHSS reduced down from 15 to 2 within 24 hours post procedure.
The Patient has made a full recovery with NIHSS 0 and MRS 0 and was discharged home in 5 days. She has been commenced on Clopidogrel 75 mg once daily and followed up at Stroke clinic in 3 months.
The views and opinions expressed here are those of Dr Nayak only and in no way represent the view, positions or opinion of Medtronic.
1 Stroke Association, ‘State of the Nation’ report 2017