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Endovascular Mechanical Thrombectomy of an Occluded Superior Division Branch of the Left MCA for Acute Cardioembolic Stroke

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Abstract

Cardiac embolism accounts for a large proportion of ischemic stroke. Revascularization using systemic or intra-arterial thrombolysis is associated with increasing risks of cerebral hemorrhage as time passes from stroke onset. We report successful mechanical thrombectomy from a distal branch of the middle cerebral artery (MCA) using a novel technique. A 72-year old man suffered an acute ischemic stroke from an echocardiographically proven ventricular thrombus due to a recent myocardial infarction. Intra-arterial administration of 4 mg rt-PA initiated at 5.7 hours post-ictus failed to recanalize an occluded superior division branch of the left MCA. At 6 hours, symptomatic embolic occlusion persisted. Mechanical extraction of the clot using an Attracter-18 device (Target Therapeutics, Freemont, CA) resulted in immediate recanalization of the MCA branch. Attracter-18 for acute occlusion of MCA branches may be considered in selected patients who fail conventional thrombolysis or are nearing closure of the therapeutic window for use of thrombolytic agents.

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Acknowledgements

Supported in part by the Horace W. Goldsmith Foundation for Cerebrovascular Research (H. Christian Schumacher, MD). We thank Trevor Winterbottom for editorial assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. The Neurological Institute, Doris & Stanley Tananbaum Stroke Center, New York Presbyterian Hospital, College of Physicians & Surgeons of Columbia University, Box 131, 710 West 168th Street, New York, NY 10032, USA

    H. C. Schumacher, D. R. Yavagal, N. Y. Harel, M. S. V. Elkind & J. P. Mohr

  2. Department of Interventional Neuroradiology, Milstein Hospital Building, 8 Knuckle South, New York Presbyterian Hospital, College of Physicians & Surgeons of Columbia University, 177 Fort Washington Avenue, New York, New York 10032, USA

    H. C. Schumacher, P. M. Meyers & J. Pile-Spellman

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  1. H. C. Schumacher
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  2. P. M. Meyers
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  3. D. R. Yavagal
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  4. N. Y. Harel
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  5. M. S. V. Elkind
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  6. J. P. Mohr
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  7. J. Pile-Spellman
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Correspondence to H. C. Schumacher.

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Schumacher, H., Meyers, P., Yavagal, D. et al. Endovascular Mechanical Thrombectomy of an Occluded Superior Division Branch of the Left MCA for Acute Cardioembolic Stroke . CVIR 26, 305–308 (2003). https://doi.org/10.1007/s00270-003-2719-5

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