Stroke intervention for middle cerebral artery thrombus in a young patient with an ipsilateral Spetzler–Martin grade V arteriovenous malformation
- Adib A Abla1,2,
- Travis M Dumont1,2,
- Peter Kan1,2,
- L Nelson Hopkins1,2,3,
- Adnan H Siddiqui1,2,3,
- Elad I Levy1,2,3
- 1Department of Neurosurgery and Toshiba Stroke Research Center, USA
- 2Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
- 3Department of Radiology, University at Buffalo, State University of New York, USA
- Correspondence to Dr Elad I Levy, University at Buffalo Neurosurgery, 100 High Street, Buffalo NY 14203, USA;
Contributors Conception and design: AAA, EIL and LNH; acquisition of the data: AAA, TMD and PK; analysis and interpretation of the data: AAA; drafting of the manuscript: AAA and TMD; critically revising the manuscript: all authors; final approval of the manuscript: all authors.
- Received 18 October 2011
- Revised 9 January 2012
- Accepted 17 January 2012
- Published Online First 19 February 2012
A patient (in their late 20s) was admitted with a right frontal stroke, left hemiparesis and hemianopsia, and a National Institutes of Health Stroke Scale (NIHSS) score of 11. CT perfusion imaging revealed an ischemic penumbra. A CT angiogram showed a Spetzler–Martin grade V arteriovenous malformation (AVM) in the right frontal lobe and a second, smaller AVM in the medial occipital region. Successful mechanical thrombectomy for middle cerebral artery thrombi improved flow from a Thrombolysis in Cerebral Infarction score of 0 to 2b. Following endovascular mechanical thrombectomy, the NIHSS dramatically improved from 11 to 2 and the patient was discharged home in 7 days. Evaluation 1 month after treatment disclosed a nearly complete recovery, with mild residual arm weakness (NIHSS 1). This case illustrates acute stroke intervention in the setting of an ipsilateral, large, high flow AVM in a young adult and is the first such reported case to our knowledge.
Competing interests LNH receives grant/research support from Toshiba; serves as a consultant to Abbott, Boston Scientific,* Cordis, Micrus and WL Gore; holds a financial interest in Access Closure, Augmenix, Boston Scientific,* Claret Medical Inc, Micrus and Valor Medical; has a board/trustee/officer position with Access Closure, Claret Medical Inc and Micrus (until September 2010); belongs to the Abbott Vascular speakers bureau; and receives honoraria from Bard, Boston Scientific,* Cordis, Memorial Healthcare System, Complete Conference Management, SCAI and Cleveland Clinic. EIL receives research grant support (principal investigator: Stent-Assisted Recanalization in acute Ischemic Stroke, SARIS), other research support (devices) and honoraria from Boston Scientific* and research support from Codman and Shurtleff Inc and ev3/Covidien Vascular Therapies; has ownership interests in Intratech Medical Ltd and Mynx/Access Closure; serves as a consultant on the board of Scientific Advisors to Codman and Shurtleff Inc; serves as a consultant per project and/or per hour for Codman and Shurtleff Inc, ev3/Covidien Vascular Therapies and TheraSyn Sensors Inc; and receives fees for carotid stent training from Abbott Vascular and ev3/Covidien Vascular Therapies. He receives no consulting salary arrangements. All consulting is per project and/or per hour. AHS has received research grants from the National Institutes of Health (coinvestigator: NINDS 1R01NS064592-01A1, Hemodynamic induction of pathologic remodeling leading to intracranial aneurysms) and the University at Buffalo (Research Development Award); holds financial interests in Hotspur, Intratech Medical, StimSox and Valor Medical; serves as a consultant to Codman and Shurtleff Inc, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting and Penumbra; belongs to the speakers bureaus of Codman and Shurtleff Inc and Genentech; serves on an advisory board for Codman and Shurtleff; and has received honoraria from American Association of Neurological Surgeons courses, an Emergency Medicine Conference, Genentech, Neocure Group LLC and from Abbott Vascular and Codman and Shurtleff Inc for training other neurointerventionists in carotid stenting and for training physicians in endovascular stenting for aneurysms. He receives no consulting salary arrangements. All consulting is per project and/or per hour. (*Boston Scientifics neurovascular business has been acquired by Stryker.)
Provenance and peer review Not commissioned; externally peer reviewed.