Abstract Details

Title Endovascular Thrombectomy in Acute-Onset Ischemic Stroke – Beyond the Standard Time Windows: A Case Report and a Review of the Literature

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-041

Objective NA

Background Endovascular thrombectomy following an acute ischemic stroke can lead to improved functional outcome when performed early. Current guidelines suggest treatment within 6 h after symptom onset. Recent studies including the DEFUSE-3 and DAWN trials demonstrate that some patients may benefit from thrombectomy up to 16 and 24 h after symptom onset, respectively.

Design/Methods NA

Results We present a case of delayed thrombectomy in a 43-year-old man with acute dysarthria, left-sided weakness, and visual neglect. Initial MRI/A demonstrated a small completed stroke and a thrombus in the right middle cerebral artery. Thirty-seven hours after symptom onset, his weakness acutely worsened. A repeat MRI revealed an unchanged core infarct volume and a cerebral angiogram suggested an abrupt occlusion of the right distal M1. Thrombectomy was performed with complete reperfusion and the patient’s strength recovered following the procedure.

Conclusions We compared our clinical reasoning with the DEFUSE-3 and DAWN study criteria, and conclude that there is a subset of patients that may safely benefit from thrombectomy in later time windows beyond the trial criteria, especially in the setting of clinical examination of imaging mismatch.

Authors/Disclosures
PRESENTER	No disclosure on file
Naveed Chaudhry, MD (University of Colorado School of Medicine)	Dr. Chaudhry has nothing to disclose.
John Cole, MD (UMD SOM)	Dr. Cole has nothing to disclose.
	No disclosure on file
Melissa Motta, MD, MPH, FAAN (University Of Maryland Hospital in Baltimore)	Dr. Motta has nothing to disclose.

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