Abstract Details

Title Cocaine- induced Vasospasm During Mechanical Thrombectomy in Acute Ischemic Stroke Patients: A Report of Two Cases

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-005

Objective N/A

Background

Cocaine causes cerebral vasospasm, vasculitis, enhanced platelet aggregation, and hypertension with altered cerebral autoregulation . The optimal treatment for large vessel occlusion due to cocaine-induced vasospasm remains unknown. Mechanical thrombectomy (MT) poses a unique challenge, and reports of successful MT are not well published . We present two patients with a common history of cocaine abuse who underwent MT with subsequent vessel re-occlusion.

Design/Methods N/A

Results Case 1: A 51-year-old woman with cocaine and marijuana abuse, and previous right MCA stroke who presented with right MCA syndrome. Initial angiography showed proximal right M1 occlusion. First pass MT yielded good revascularization with subsequent re-occlusion on delayed run. A second pass yielded only partial re-canalization, prompting two angioplasties followed by stenting, all with recurrent occlusion. The patient developed a complete right MCA infarct, requiring a hemicraniectomy due to malignant MCA syndrome.

Case 2: A 46-year-old man with a history of right MCA stroke, cocaine and tobacco abuse who presented with coma after he was found unresponsive in a drug house. Vessel imaging showed right MCA, bilateral vertebral, and proximal basilar artery occlusions. MT of the left vertebral and proximal basilar arteries was attempted after Verapimil infusion. The catheter was unable to cross the clot, and the procedure was aborted. The patient developed pontine, bilateral cerebellar, and left occipital infarcts, requiring a decompressive occipital craniectomy. His exam deteriorated, and he expired after withdrawal of care.

Conclusions

In this case series, cocaine- induced vasospasm led to unsuccessful recanalization and frequent re-occlusion in patients undergoing mechanical thrombectomy. Cocaine use may cause worsening outcomes in MT due to intracranial atherosclerosis, and vasculitis, in addition to vasospasm. Further studies are needed to better delineate the therapeutic interventions in patients with acute large vessel occlusions secondary to cocaine use.

Authors/Disclosures
Marina Kushnirsky, MD PRESENTER	Dr. Kushnirsky has nothing to disclose.
Muhammad Z. Memon, MD	Dr. Memon has nothing to disclose.
Robert Starke	Robert Starke has nothing to disclose.
	No disclosure on file
Dileep R. Yavagal, MD, FAAN (University of Miami Miller School of Medicine)	Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vascular Dynamics. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. The institution of Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus/Johnson & Johnson. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Poseydon. Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Athersys. Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gravity Medical Technology. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Poseydon. Dr. Yavagal has stock in Poseydon. Dr. Yavagal has stock in Galaxy Therapeutics. Dr. Yavagal has stock in Stentrode. Dr. Yavagal has stock in Gravity Medical. Dr. Yavagal has stock in Gravity Medical Technology. Dr. Yavagal has stock in Athersys. Dr. Yavagal has stock in Rapid Medical . Dr. Yavagal has received intellectual property interests from a discovery or technology relating to health care. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Expert with Royal Carribean Cruise Line. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Consultant with Carnival Cruise Line.

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