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Abstract Details

Double Trouble: Successful Thombectomy for Recurrent, Contralateral M2 Occlusions
Cerebrovascular Disease and Interventional Neurology
P9 - Poster Session 9 (12:00 PM-1:00 PM)
4-009
To discuss etiology and utility of repeat thrombectomy in a patient who developed contralateral M2 occlusions.
Acute endovascular therapy (EVT) is a revolutionary treatment for patients with large vessel occlusions (LVO). Data regarding EVT of recurrent LVOs is scarce; 1.4-2% of stroke patients received repeat EVT for recurrent LVOs, and only small subsets had M2 occlusions or contralateral LVOs. 
 A 71-year-old female presented with acute left sided weakness. She was not a tPA candidate due to anticoagulation for atrial fibrillation. CT angiogram demonstrated a right M2 occlusion with ASPECT score of 9. EVT was performed with TICI 3. Due to petechial hemorrhage, anticoagulation was held for one week. Her NIH improved from 12 to 1 at discharge. She returned to the emergency department within 3 hours of discharge with right sided weakness and aphasia (NIH 17). CT angiogram demonstrated left M2 occlusion with ASPECT score of 10.
The patient had repeat EVT with TICI 3. Transesophageal echocardiogram showed no evidence of left atrial thrombus. The etiology of her recurrent LVOs was likely secondary to insufficient anticoagulation. She was discharged home on anticoagulation with NIH 1 for residual facial droop (MRS 1). 
Previous retrospective studies of repeat thrombectomy demonstrated MRS ≤ 2 in 60% of cases, TICI ≥ 2B in nearly 90% of cases, mortality rate of 20%, and minimal rates of intraparenchymal hemorrhage. The mean time to repeat EVT was 71-141 days, significantly longer than the 5 days in our patient. Nearly all cases of recurrent contralateral LVO were secondary to cardioembolism due to insufficient anticoagulation. Larger studies are needed to determine the optimal time to restart anticoagulation. Repeat thrombectomy appears to be a safe and effective procedure for recurrent LVO but larger, randomized studies are needed to determine which patient population is most appropriate for this intervention.
Authors/Disclosures
Jessica Frey, MD (West Virginia University)
PRESENTER 		The institution of Dr. Frey has received research support from Tourette Association of America.
Amelia K. Adcock, MD (WVU School of Medicine, Dept. of Neurology) The institution of an immediate family member of Dr. Adcock has received research support from NIH.