title: Endovascular mechanical thrombectomy of an occluded superior division branch of the left MCA for acute cardioembolic stroke.
abstract: Cardiac embolism accounts for a large proportion of ischemic stroke. Revascularization using systemic or intra-arterial thrombolysis is associated with increasing risks of cerebral hemorrhage as time passes from stroke onset. We report successful mechanical thrombectomy from a distal branch of the middle cerebral artery (MCA) using a novel technique. A 72-year old man suffered an acute ischemic stroke from an echocardiographically proven ventricular thrombus due to a recent myocardial infarction. Intraarterial administration of 4 mg rt-PA initiated at 5.7 hours post-ictus failed to recanalize an occluded superior division branch of the left MCA. At 6 hours, symptomatic embolic occlusion persisted. Mechanical extraction of the clot using an Attracter-18 device (Target Therapeutics, Freemont, CA) resulted in immediate recanalization of the MCA branch. Attracter-18 for acute occlusion of MCA branches may be considered in selected patients who fail conventional thrombolysis or are nearing closure of the therapeutic window for use of thrombolytic agents.
authors.affiliation: The Neurological Institute, Doris & Stanley Tananbaum Stroke Center, New York Presbyterian Hospital, College of Physicians & Surgeons of Columbia University, Box 131, 710 West 168th Street, New York, NY 10032, USA. hs775@columbia.edu
authors.forename: H C
authors.initials: HC
authors.lastname: Schumacher
authors.forename: P M
authors.initials: PM
authors.lastname: Meyers
authors.forename: D R
authors.initials: DR
authors.lastname: Yavagal
authors.forename: N Y
authors.initials: NY
authors.lastname: Harel
authors.forename: M S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.forename: J
authors.initials: J
authors.lastname: Pile-Spellman
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D004452:Echocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis; D017131:Thrombectomy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator