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Transradial Mechanical Thrombectomy for Proximal Middle Cerebral Artery Occlusion in a First Trimester Pregnancy: Case Report and Literature Review.

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.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Shah SS,Snelling BM,Brunet MC,Sur S,McCarthy DJ,Stein A,Khandelwal P,Starke RM,Peterson EC

doi

10.1016/j.wneu.2018.09.095

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

415-419

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)32141-7

journal_volume

120

pub_type

杂志文章

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