Abstract Details

Title Successful Intravenous Thrombolysis Followed by Mechanical Thrombectomy in a Patient with Cerebral Ischemia and a Dural AV Fistula: A Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 253

Objective

Background BACKGROUND: A patient with acute ischemic stroke underwent intravenous thrombolysis and subsequent mechanical thrombectomy without complication despite an incidentally noted dural AV fistula (DAVF). No prior studies or case reports are available regarding the use of thrombolytics and endovascular clot retrieval in the setting of a DAVF.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 75-year-old woman presented with acute onset of left hemiplegia. Her NIH Stroke Scale (NIHSS) was 10. Head computed tomography (CT) showed a right hyperdense distal internal carotid artery and middle cerebral artery, but was otherwise negative. Intravenous thrombolytic was administered without clinical improvement of symptoms. CT Perfusion showed a large penumbra correlating with the middle cerebral artery (MCA) distribution. CT angiogram and subsequent conventional angiogram revealed a carotid T occlusion in addition to an incidental ipsilateral frontal dural arteriovenous (AV) fistula. Mechanical thrombectomy was successful in removal of the thrombus. At time of discharge her NIHSS was 0. There were no hemorrhagic complications.

Conclusions CONCLUSIONS: The actual risk of thrombolytic and/or mechanical-associated intracranial hemorrhage in the setting of a DAVF is unknown. Since the CT did not show evidence of an abnormality, intravenous thrombolysis was reasonable. Given the high morbidity of carotid occlusion, we felt aggressive mechanical clot retrieval in this setting was also justified. In patients with known DAVF or with evidence of DAVF on CT, decisions regarding acute intervention in the case of ischemic stroke should be individualized.

Authors/Disclosures
Brian S. Katz, MD (OhioHealth Neurological Physicians) PRESENTER	No disclosure on file
Kelly D. Flemming, MD (Mayo Clinic)	Dr. Flemming has nothing to disclose.
Per Soelberg Sorensen	No disclosure on file

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