Transradial Mechanical Thrombectomy for Proximal Middle Cerebral Artery Occlusion in a First Trimester Pregnancy: Case Report and Literature Review

被引:27
作者
Shah, Sumedh S. [1 ]
Snelling, Brian M. [3 ]
Brunet, Marie Christine [1 ]
Sur, Samir [1 ]
McCarthy, David J. [1 ]
Stein, Alan [1 ]
Khandelwal, Priyank [1 ]
Starke, Robert M. [1 ,2 ]
Peterson, Eric C. [1 ]
机构
[1] Univ Miami, Miller Sch Med, Dept Neurosurg, Miami, FL 33136 USA
[2] Univ Miami, Miller Sch Med, Dept Radiol, Miami, FL 33136 USA
[3] Boca Raton Reg Hosp, Marcus Neurosci, Boca Raton, FL USA
关键词
Mechanical thrombectomy; Pregnancy; Transradial access; ACUTE ISCHEMIC-STROKE; THERAPY;
D O I
10.1016/j.wneu.2018.09.095
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Acute ischemic stroke in pregnancy is a cause of maternal and fetal morbidity. Optimal treatment strategies for stroke in this population are undefined. Thrombolysis is recommended by guidelines should the benefit outweigh uterine bleeding risk. Alternately, data regarding mechanical thrombectomy (MT) is extremely limited. We present a 37-year-old woman in the first trimester that developed recurrent proximal middle cerebral artery (MCA) occlusion after previous thrombolysis and underwent MT via transradial access. This report of transradial MT represents the first case performed through an extrafemoral route for large vessel occlusion in early pregnancy found in the literature. CASE DESCRIPTION: A 37-year-old gravida 8 para 7 at 9 weeks' gestation presented with left-sided hemiplegia and right gaze preference and underwent successful thrombolysis for a right MCA occlusion. Two days later, she exhibited the same symptoms, and a reoccluded right MCA was identified. Because thrombolysis was unavailable given the recent stroke, the patient underwent emergentMTvia radial access (to minimize fetal radiation exposure) and achieved thrombolysis in cerebral infarction 2b revascularization without complication to her or her child. At 2-month follow-up, the patient is on anticoagulation and has a healthy pregnancy with only minor left-sided facial weakness. CONCLUSIONS: When thrombolysis is contraindicated, thrombectomy should be considered and weighed against risks of fetal radiation exposure and contrast load, especially in early pregnancy. Transradial MT is safe, feasible, and mitigates pelvic radiation. A multidisciplinary approach with obstetrics, stroke teams, and neurointerventionalists is vital for successful therapy.
引用
收藏
页码:415 / 419
页数:5
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