Successful outcome after endovascular thrombolysis for acute ischemic stroke with basis on perfusion-diffusion mismatch after 24 h of symptoms onset.
BACKGROUND
Although intravenous thrombolysis is the Food and Drug Administration-approved treatment for acute ischemic stroke (AIS) within 3 h, combined intravenous and intra-arterial thrombolysis with endovascular techniques may be able to extend this traditional time window.


METHODS
We present the clinical evolution of a 45-year-old male presenting with acute left hemiparesis. Magnetic resonance imaging revealed a small diffusion restriction at the right basal ganglia with perfusion compromise in the entire right middle cerebral artery (MCA) territory. Angiography revealed a complete occlusion of MCA at its M1 segment. The patient underwent endovascular mechanical thrombectomy with additional intra-arterial thrombolysis more than 24 hours after the onset of the initial symptoms and experienced complete vessel recanalization. At 1 year, the patient had global independence with minor residual motor impairment in the left arm.


CONCLUSIONS
We report the case of a successful thrombolytic therapy following AIS performed more than 24 h after the initial symptoms based on the presence of a perfusion-diffusion mismatch. This report is expected to stimulate the development of future prospective studies with special focus on the role of perfusion-diffusion mismatch in patient selection for treatment of AIS, especially in those presenting outside the traditional time window.
Department of Neurosurgery, Brain and Spine Center, Invision Health, Buffalo, New York, USA.
Tobias A
TA
Mattei
University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Azeem A
AA
Rehman
Department of Neurosurgery, SUNY Upstate Medical University, Curitiba, Brazil.
Carlos R
CR
Goulart
Instituto de Neurologia de Curitiba, Curitiba, Brazil.
Marília G
MG
Sória
Instituto de Neurologia de Curitiba, Curitiba, Brazil.
Vanessa
V
Rizelio
Instituto de Neurologia de Curitiba, Curitiba, Brazil.
Murilo S
MS
Meneses
Acute ischemic stroke; intra-arterial thrombolysis; mechanical thrombectomy; perfusion-diffusion mismatch; thrombolysis