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Abstract
Introduction Previous randomized clinical trials (RCTs) have supported the use of endovascular therapy (EVT) in late-window acute ischemic stroke (AIS) 6– 24 hours from time last known well (TLKW). But there is no evidence about the use of EVT in very late time window AIS (VLTW;>24 hours)
Case Description We report the case of 56-year-old man with left hemiparesis, left hemianopy, dysarthria. He felt left side weakness and speech impairment on July 27 around 11:00 AM. He thought that he was just tired. On the morning of July 28, the symptoms worsened to moderate weakness in the left extremities, making it impossible for him to walk independently. His vision and speech also deteriorated. He arrived to the hospital at 12:00 with NIHSS 10. The MRI showed DWI lesions, thrombosis of the M2 segment of the right middle cerebral artery (MCA) and hypointense signal on the SWI (figure 1)
A thrombosis of the M2 of the right MCA (signal from thrombus on SWI and signal loss from the M2 of the right MCA on TOF) and hypointense signal on the SWI (considering as penumbra based on asymmetrical prominent cortical veins compared with the other normal site)
Based on DAWN trial criteria and thrombosis of the M2 right MCA we considered to perform EVT.
Result-eTICI 2C at 14.20 (time to recanalization 27h 20m) (figure 2)
EVT - Technique - ADAPT, recanalization - eTICI 2C
MRI after 24 hour – several infarct lesions and hemorrhagic transformation (type HI-2) (figure 3)
MRI after 24 hour - several infarct lesions, recanalization of M2 segment of the right MCA (TOF) and hemorrhagic transformation (type HI-2)
At discharge NIHSS - 4; mRs – 3. mRs at day 90- 1.
Results The safety and functional outcome of EVT in the VLTW from AIS onset remains undetermined. Probably it may achieve favorable clinical outcomes and high reperfusion rates. RCTs assessing the efficacy of EVT in the VLTW are warranted, but will be feasible with a large international collaborative approach.
Disclosure of Interest no.