Early secondary prevention after initially ineffective revascularization treatments for acute ischemic stroke due to tandem occlusion.
: The most effective treatment of patients with stroke due to tandem occlusion is still unclear. We report the case of a man with stroke due to tandem internal carotid artery/middle cerebral artery occlusion, who underwent initially ineffective intravenous thrombolysis (IVT) and endovascular treatment. Early anticoagulation with apixaban was started after 48 h of IVT, given a newly diagnosed nonvalvular atrial fibrillation. Spontaneous partial recanalization of the cervical internal carotid artery was noted, and carotid endarterectomy was performed 72 h after IVT and 8 h after the last dose of apixaban. Surgery was conducted without any complication and the patient was discharged 7 days after onset with a residual mild hemiparesis. This is the first report of urgent carotid endarterectomy in an anticoagulated patient receiving a direct oral anticoagulant. This case highlights the importance of an early multidisciplinary approach to achieve a successful treatment of stroke due to tandem occlusion.
Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
Stefano
S
Forlivesi
Elia
E
Pancheri
Giuseppe
G
Moretto
Paolo
P
Bovi
Manuel
M
Cappellari
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000601:surgery; D016894:Endarterectomy, Carotid; D006801:Humans; D020244:Infarction, Middle Cerebral Artery; D008297:Male; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000628:therapy*
D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban