title: MRI assessment followed by successful mechanical recanalization of a complete tandem (internal carotid/middle cerebral artery) occlusion and reversal of a 10-hour fixed deficit.
abstract: BACKGROUND
  Mechanical clot extraction up to 8 hours after stroke onset is an alternative strategy for opening large vessels, especially for patients ineligible for intravenous thrombolysis. Safety beyond this therapeutic window is untested.
  
  
  METHODS
  An 81-year-old woman presented 8 hours after she developed left-sided weakness and dysarthria with a National Institutes of Health Stroke Scale (NIHSS) score fluctuating between 6 and 13. Neuroimaging revealed a large perfusion deficit with no diffusion abnormalities. An emergent cerebral angiogram revealed a complete internal carotid artery terminus occlusion.
  
  
  RESULTS
  Successful mechanical thrombectomy was performed without complication and resulted in almost complete reversal of the patient's deficit to an NIHSS score of 1, 10 hours after stroke onset.
  
  
  CONCLUSIONS
  Patients with large hypoperfused areas and minimal diffusion abnormalities on the MRI may benefit from mechanical thrombectomy beyond an 8-hour window.
authors.affiliation: Departments of Neurology and Neurosurgery, Stroke/ Neurocritical Care Division, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Catalina C
authors.initials: CC
authors.lastname: Ionita
authors.forename: Junichi
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Ramachandra P
authors.initials: RP
authors.lastname: Tummala
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
mesh_terms: D000369:Aged, 80 and over; D002341:Carotid Artery Thrombosis / Q000175:diagnosis* / Q000628:therapy*; D002343:Carotid Artery, Internal; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000628:therapy*; D017131:Thrombectomy