Background and Aims
Acute treatment of large vessel occlusion in acute ischemic stroke (AIS) has clear recommendations. Solving minor ischemic events in the catchment area of a severely stenotic or closed artery often does not have clear, sufficient recommendations outside of the intervention time window.
Methods
The patient (male, 66 years old) was admitted in June for an AIS due to occlusion of the left middle cerebral artery(MCA). Intravenous thrombolysis was administered and mechanical embolectomy was performer with complete recanalization. In November, he was admitted for a phatic lesion lasting several days. Stenosis of MCA was detected on CTA. An endovascular procedure was not indicated after considering the risk of the procedure and the clinic. In December, he was admitted with a phatic disorder. CTA demonstrated preocclusion of MCA. Chronic hypoperfusion was confirmed. Furthermore, AIS was confirmed in the field of minor hypoperfusion ischemias of various ages. The patient underwent emergency surgery on the same day (extra-intracranial anastomosis). During the operation, occlusion of the branch of the MCA M3/4 was also diagnosed. Neurosurgical thrombectomy with complete recanalization was performed.
Results
In the postoperative period, the clinical condition changes to the old small right-sided deficit. Follow-up imaging showed improvement in perfusion of the MCA basin. The operation and the postoperative course were without complications.
Conclusion
Mistaking the recurrence of an AIS for undetected hypoperfusion in the catchment area of a chronically severely stenosed or closed artery can have a significant negative impact on the fate of the patient.