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

Sumedh S. Shah, Brian M. Snelling, Marie Christine Brunet, Samir Sur, David J. McCarthy, Alan Stein, Priyank Khandelwal, Robert M. Starke, Eric Peterson

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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 emergent MT via 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.

Original languageEnglish (US)
Pages (from-to)415-419
Number of pages5
JournalWorld Neurosurgery
Volume120
DOIs
StatePublished - Dec 1 2018

Fingerprint

Thrombectomy
Middle Cerebral Artery Infarction
First Pregnancy Trimester
Pregnancy
Stroke
Mechanical Thrombolysis
Hemiplegia
Uterine Hemorrhage
Cerebral Infarction
Middle Cerebral Artery
Obstetrics
Mothers
Guidelines
Radiation
Morbidity
Therapeutics
Population

Keywords

  • Mechanical thrombectomy
  • Pregnancy
  • Transradial access

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Transradial Mechanical Thrombectomy for Proximal Middle Cerebral Artery Occlusion in a First Trimester Pregnancy : Case Report and Literature Review. / Shah, Sumedh S.; Snelling, Brian M.; Brunet, Marie Christine; Sur, Samir; McCarthy, David J.; Stein, Alan; Khandelwal, Priyank; Starke, Robert M.; Peterson, Eric.

In: World Neurosurgery, Vol. 120, 01.12.2018, p. 415-419.

Research output: Contribution to journalArticle

Shah, SS, Snelling, BM, Brunet, MC, Sur, S, McCarthy, DJ, Stein, A, Khandelwal, P, Starke, RM & Peterson, E 2018, 'Transradial Mechanical Thrombectomy for Proximal Middle Cerebral Artery Occlusion in a First Trimester Pregnancy: Case Report and Literature Review', World Neurosurgery, vol. 120, pp. 415-419. https://doi.org/10.1016/j.wneu.2018.09.095
Shah, Sumedh S. ; Snelling, Brian M. ; Brunet, Marie Christine ; Sur, Samir ; McCarthy, David J. ; Stein, Alan ; Khandelwal, Priyank ; Starke, Robert M. ; Peterson, Eric. / Transradial Mechanical Thrombectomy for Proximal Middle Cerebral Artery Occlusion in a First Trimester Pregnancy : Case Report and Literature Review. In: World Neurosurgery. 2018 ; Vol. 120. pp. 415-419.
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AB - 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 emergent MT via 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.

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