Introduction: Ischemic stroke due to internal carotid artery occlusion is often refractory to intravenous thrombolysis and generally has a poor outcome with high morbidity and mortality. Patients with ischemic stroke due to middle cerebral artery stroke that is excluded from intravenous thrombolysis also has a similar outcome.
Methods: We report a case series of four patients who presented with acute ischemic strokes and underwent intra-arterial embolectomy with favourable outcomes. All were excluded for intravenous thrombolysis due to either delayed time of presentation (> 3 hours) or the presence of at least another exclusion criteria. Eligibility for intra-arterial embolectomy was determined by demonstrating a mismatch on CT brain angiography and perfusion scans, thus identifying potentially salvageable tissue. Two patients had middle cerebral artery embolus occlusion and two had internal carotid artery embolus occlusion. We performed mechanical extraction of the embolus using a Solitaire device with or without penumbra endovascular device in selected patients.
Results: All patients had substantial improvement in their clinical status with a mean NIHSS score of 9.5 (range 6-13 and SD = 2.8) before the procedure, a NIHSS score of 2 (range 1-3, SD = 0.8) at 24 hours post procedure with a mean difference of 7.5 (range 4-11, SD = 2.8). Two patients developed small and clinically insignificant revascularization hemorrhage.
Conclusion: Intra-arterial embolectomy seems to be a safe and rapid alternative method of vascular recanalization for treatment of acute ischemic stroke due to embolic occlusion of the ICA/MCA. Further evaluation with randomized controlled trials is warranted.