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Transradial Mechanical Thrombectomy for Proximal Middle Cerebral Artery Occlusion in a First Trimester Pregnancy: Case Report and Literature Review
- Source :
- World Neurosurgery. 120:415-419
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Acute ischemic stroke in pregnancy is a cause of maternal and fetal morbidity. Optimal treatment strategies for stroke in this population are undefined. Thrombolysis is recommended by guidelines should the benefit outweigh uterine bleeding risk. Alternately, data regarding mechanical thrombectomy (MT) is extremely limited. We present a 37-year-old woman in the first trimester that developed recurrent proximal middle cerebral artery (MCA) occlusion after previous thrombolysis and underwent MT via transradial access. This report of transradial MT represents the first case performed through an extrafemoral route for large vessel occlusion in early pregnancy found in the literature. Case Description A 37-year-old gravida 8 para 7 at 9 weeks' gestation presented with left-sided hemiplegia and right gaze preference and underwent successful thrombolysis for a right MCA occlusion. Two days later, she exhibited the same symptoms, and a reoccluded right MCA was identified. Because thrombolysis was unavailable given the recent stroke, the patient underwent emergent MT via radial access (to minimize fetal radiation exposure) and achieved thrombolysis in cerebral infarction 2b revascularization without complication to her or her child. At 2-month follow-up, the patient is on anticoagulation and has a healthy pregnancy with only minor left-sided facial weakness. Conclusions When thrombolysis is contraindicated, thrombectomy should be considered and weighed against risks of fetal radiation exposure and contrast load, especially in early pregnancy. Transradial MT is safe, feasible, and mitigates pelvic radiation. A multidisciplinary approach with obstetrics, stroke teams, and neurointerventionalists is vital for successful therapy.
- Subjects :
- Adult
medicine.medical_specialty
Computed Tomography Angiography
medicine.medical_treatment
Pregnancy Complications, Cardiovascular
Population
030204 cardiovascular system & hematology
Revascularization
03 medical and health sciences
0302 clinical medicine
Pregnancy
Recurrence
medicine.artery
Occlusion
medicine
Humans
Thrombolytic Therapy
education
Stroke
Thrombectomy
education.field_of_study
business.industry
Cerebral infarction
Endovascular Procedures
Infarction, Middle Cerebral Artery
Thrombolysis
medicine.disease
Magnetic Resonance Imaging
Cerebral Angiography
Surgery
Pregnancy Trimester, First
Radial Artery
Middle cerebral artery
Female
Neurology (clinical)
Tomography, X-Ray Computed
business
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 120
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....34145cdb5251ecafb3fd6790f305c820