Use of multimodal MRI and novel endovascular therapies in a patient ineligible for intravenous tissue plasminogen activator.
OBJECTIVE
Options are limited for individuals who present to the ED within 3 hours of ischemic stroke onset, but who are deemed ineligible for intravenous thrombolysis. Multimodal MRI has been shown to be of great help in identifying stroke patients with large areas of at risk "penumbral tissue", who may gain from the use of novel endovascular therapies. We report a patient who twice benefited from this management approach, in the setting of hemorrhagic risk following successive ischemic strokes.


METHODS
The patient is a 78 year old male who experienced acute ischemic stroke on 2 separate occasions 5 months apart, and for whom perceived contraindications to appropriate thrombolytic therapy administration led to the successful use of different endovascular therapies at each encounter. Furthermore, following mechanical clot retrieval during the second encounter, the high intensity signal area noted on the baseline diffusion weighted imaging (DWI) in the posterior circulation territory, was almost completely resolved on the day 7 post-procedure MRI.


CONCLUSIONS
To our knowledge, this is the first reported case of reversal of a DWI abnormality in the posterior circulation territory.
Suzuki
Shuichi
S
Department of Radiology, UCLA Medical Center, Los Angeles, California, USA.
Kidwell
Chelsea S
CS
Starkman
Sidney
S
Saver
Jeffrey L
JL
Duckwiler
Gary
G
Vinuela
Fernando
F
Ovbiagele
Bruce
B
D000368:Aged; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002545:Brain Ischemia / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002404:Catheterization / Q000295:instrumentation; D002544:Cerebral Infarction / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020768:Middle Cerebral Artery / Q000473:pathology; D012306:Risk; D020521:Stroke / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator