A Case for Thrombectomy: Acute Onset Hemiparesis from a Large Vessel Occlusion

Introduction

There have been significant advances in the treatment of stroke in the last decade, and mechanical thrombectomy is the new standard of care for the treatment of stroke due to large vessel occlusion (LVO) (  ). We describe a case of an elderly man with an acute stroke secondary to LVO and present images demonstrating the use of mechanical thrombectomy.

Case Report

A 91-year-old man with a history of atrial fibrillation on apixaban presented with sudden onset confusion 45 min prior to arrival. He was noted to be nonverbal with right facial droop, right hemiparesis, and a National Institutes of Health Stroke Scale score of 26. A stroke code was activated and an acute occlusion of the first segment of the left middle cerebral artery was found on computed tomography angiography (CTA) scan of the head and neck ( Figure 1 ). Soon after the imaging was obtained, the patient started aspirating and required emergent intubation for airway protection. The patient was then taken for immediate endovascular thrombectomy to remove a large clot ( Figure 2 ). After thrombectomy, the patient had complete reperfusion of the affected vascular territory. Unfortunately, the patient could not be weaned from the ventilator and was transitioned to comfort care 1 week later.

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