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A clinical case of mechanical recanalization of recurrent cerebral embolism in the hyperacute period of ischemic stroke with hemorrhagic transformation

https://doi.org/10.14412/2074-2711-2022-4-44-50

Abstract

Currently, there is no single algorithm for the treatment of acute tandem occlusion of the internal carotid artery (ICA) and middle cerebral artery (MCA). The article presents the clinical case of ischemic stroke, which developed 10 days after the first ischemic episode with hemorrhagic transformation. As reperfusion therapy, thrombectomy from the M1 segment of the left MCA and simultaneous stenting of the left ICA were performed. The use of dual antiplatelet therapy at a loading dose in this clinical case was justified by the risk of stent thrombosis, but this increased the risk of recurrent hemorrhagic transformation. Follow-up of the patient for 90 days after this vascular event showed a favorable clinical outcome without hemorrhagic complications. The presented clinical case is extremely rare and shows one of the possible approaches in the management of patients with tandem lesions of the brachiocephalic arteries with a history of intracranial hemorrhagic complications. To develop a unified algorithm for managing acute tandem occlusion in recurrent ischemic strokes, more observations are needed.

About the Authors

D. M. Murtazalieva
City Clinical Hospital named after V.V. Veresaev, Department of Health of Moscow
Russian Federation

Dzhavgarat Magomedovna Murtazalieva
127644, Moscow, Lobnenskaya St., 10


Competing Interests:

There are no conflicts of interest.



A. R. Zakaryaeva
City Clinical Hospital named after V.V. Veresaev, Department of Health of Moscow
Russian Federation

127644, Moscow, Lobnenskaya St., 10


Competing Interests:

There are no conflicts of interest.



M. V. Strutsenko
City Clinical Hospital named after V.V. Veresaev, Department of Health of Moscow
Russian Federation

127644, Moscow, Lobnenskaya St., 10


Competing Interests:

There are no conflicts of interest.



I. Y. Osipov
City Clinical Hospital named after V.V. Veresaev, Department of Health of Moscow
Russian Federation

127644, Moscow, Lobnenskaya St., 10


Competing Interests:

There are no conflicts of interest.



Z. S. Shogenov
City Clinical Hospital named after V.V. Veresaev, Department of Health of Moscow
Russian Federation

127644, Moscow, Lobnenskaya St., 10


Competing Interests:

There are no conflicts of interest.



References

1. Adams HP, Brott TG, Furlan AJ, et al. Guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 1996 Sep;27(9):1711-8.

2. Ding D. Endovascular Mechanical Thrombectomy for Acute Ischemic Stroke: A New Standard of Care. J Stroke. 2015 May;17(2):123-6. doi:10.5853/jos.2015.17.2.123. Epub 2015 May 29.

3. Kidwell CS, Jahan R, Gornbein J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013 Mar 7;368(10):914-23. doi:10.1056/NEJMoa1212793. Epub 2013 Feb 8.

4. Sergeev DV, Lavrentyeva AN, Krotenkova MV. Method of perfusion computed tomography in the diagnosis of acute ischemic stroke. Annaly klinicheskoy i eksperimental’noy nevrologii. 2008;2(3):30-7. doi:10.17816/psaic397 (In Russ.)

5. Albers GW, Goyal M, Jahan R, et al. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol. 2016 Jan;79(1):76-89. doi:10.1002/ana.24543. Epub 2015 Dec 12.

6. Laible M, Möhlenbruch M, Hacke W, et al. Repeated Intra-Arterial Thrombectomy within 72 Hours in a Patient with a Clear Contraindication for Intravenous Thrombolysis. Case Rep Vasc Med. 2015;2015:872817. doi:10.1155/2015/872817. Epub 2015 Jan 27.

7. Pirson FAV, van Oostenbrugge RJ, van Zwam WH, et al. Repeated Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: Results From a Nationwide Multicenter Database. Stroke. 2020 Feb;51(2):526-32. doi:10.1161/STROKEAHA.119.027525. Epub 2019 Dec 23.

8. Thomalla G, Simonsen CZ, Boutitie F, et al; WAKE-UP Investigators. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med. 2018 Aug 16;379(7):611-22. doi:10.1056/NEJMoa1804355. Epub 2018 May 16.

9. Albers GW, Marks MP, Kemp S, et al; DEFUSE 3 Investigators. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018 Feb 22;378(8):708-18. doi:10.1056/NEJMoa1713973. Epub 2018 Jan 24.

10. Higashida RT, Furlan AJ, Roberts H, et al; Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology; Technology Assessment Committee of the Society of Interventional Radiology. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003 Aug;34(8):e109-37. doi:10.1161/01.STR.0000082721.62796.09. Epub 2003 Jul 17. Erratum in: Stroke. 2003 Nov;34(11):2774.

11. Frenkel MB, Renfrow JJ, Singh J, et al. Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: case report. J Neurosurg. 2018 Sep;129(3):718-22. doi:10.3171/2017.6.JNS162368. Epub 2017 Nov 17.

12. Rangel-Castilla L, Rajah GB, Shakir HR, et al. Management of acute ischemic stroke due to tandem occlusion: should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first? Neurosurg Focus. 2017 Apr;42(4):E16. doi:10.3171/2017.1.FOCUS16500

13. Khripun AI, Mironkov AB, Likharev AYu, et al. Endovascular treatment of tandem occlusion of internal carotid and middle cerebral arteries in acute ischemic stroke. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2019;119(3-2):37-44. doi:10.17116/jnevro201911903237 (In Russ.)

14. Enomoto Y, Yoshimura S. Antiplatelet therapy for carotid artery stenting. Intervent Neurol. 2013 Sep;1(3-4):151-63. doi:10.1159/000351686

15. Johnston SC, Easton JD, Farrant M, et al; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med. 2018 Jul 19;379(3):215-25. doi:10.1056/NEJMoa1800410. Epub 2018 May 16.

16. Khazaal O, Rothstein A, Husain MR, et al. Dual-Antiplatelet Therapy May Not Be Associated With an Increased Risk of In-hospital Bleeding in Patients With Moderate or Severe Ischemic Stroke. Front Neurol. 2021 Sep 20;12:728111. doi:10.3389/fneur.2021.728111

17. Thomas SE, Plumber N, Venkatapathappa P, Gorantla V. A Review of Risk Factors and Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke. Int J Vasc Med. 2021 Dec 6;2021:4244267. doi:10.1155/2021/4244267

18. Hankey GJ. Dual antiplatelet therapy in acute transient ischemic attack andminor stroke. N Engl J Med. 2013 Jul 4;369(1):82-3. doi:10.1056/NEJMe1305127. Epub 2013 Jun 26.

19. Khasanova DR, Kalinin MN, Ibatullin MM, Rakhimov ISh. The haemorrhagic transformation of cerebral infarction: classification, pathogenesis, predictors and effect on the functional outcome. Annaly klinicheskoy i eksperimental’noy nevrologii. 2019;13(2):47-59 (In Russ.)

20. Whiteley WN, Slot KB, Fernandes P, et al. Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies. Stroke. 2012 Nov;43(11):2904-9. doi:10.1161/STROKEAHA.112.665331. Epub 2012 Sep 20.

21. Petrov MG, Kucherenko SS, Topuzova MP. Hemorrhagic transformation of ischemic stroke. Arterial'naya gipertenziya = Arterial Hypertension. 2021;27(1):41-50. doi:10.18705/1607-419X2021-27-1-41-50 (In Russ.)

22. Hao Y., Zhang Z., Zhang H, et al. Risk of intracranial hemorrhage afterendovascular treatment for acute ischemic stroke: systematic review and meta-analysis. Interv Neurol. 2017 Mar;6(1-2):57-64. doi:10.1159/000454721. Epub 2017 Jan 19.

23. Tan S, Wang D, Liu M, et al. Frequency and predictors of spontaneous hemorrhagic transformation in ischemic stroke and its association with prognosis. J Neurol. 2014 May;261(5):905-12. doi:10.1007/s00415-014-7297-8. Epub 2014 Mar 4.

24. Thevathasan A, Naylor J, Churilov L, et al. Association between hemorrhagic transformation after endovascular therapy and poststroke seizures. Epilepsia. 2018 Feb;59(2):403-9. doi:10.1111/epi.13982. Epub 2017 Dec 30.

25. Kalinin MN, Khasanova DR, Ibatullin MM. The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke. BMC Neurol. 2017 Sep 7;17(1):177. doi:10.1186/s12883-017-0958-3

26. Sofi F, Marcucci R, Gori AM, et al. Residual platelet reactivity on aspirin therapy and recurrent cardiovascular events – a metaanalysis. Int J Cardiol. 2008 Aug 18;128(2):166-71. doi:10.1016/j.ijcard.2007.12.010. Epub 2008 Feb 1.


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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)