Neurointervention.  2013 Sep;8(2):115-119. 10.5469/neuroint.2013.8.2.115.

Safe Implementation of Mechanical Thrombectomy in Acute Stroke Patients with Major Arterial Occlusion and Concomitant Subdural Hematoma

• Kim YW
• Kang DH
• Hwang YH
• Kim YS
• Park SP

• KMID: 1784029
• DOI: http://doi.org/10.5469/neuroint.2013.8.2.115

Abstract

Mechanical thrombectomy (MT) alone in cases of large-vessel acute ischemic stroke (AIS) with a concomitant subdural hematoma (SDH) seems feasible and safe, but there's still a lack of evidence in the clinical literature. We report three cases of AIS with SDH, of which MT was performed with successful recanalization and no major changes in SDH: two elderly men with acute traumatic SDH and one man with incidental chronic SDH. (1) A 67-year-old man with acute traumatic SDH in the right side developed right middle cerebral artery (MCA) stroke, (2) a 72-year-old man with chronic SDH in the left side developed right MCA stroke, and (3) a 76-year-old-man with acute traumatic SDH in the right side developed top-of-basilar artery syndrome. As for AIS patients with a SDH, MT may be the only feasible and safe treatment option.

Keyword

Acute ischemic stroke; Subdural hematoma; Mechanical thrombectomy

MeSH Terms

Aged
Arteries
Hematoma, Subdural
Humans
Male
Middle Cerebral Artery
Stroke
Thrombectomy

Figure

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  Fig. 1 Summary of imaging and angiographic findings in 3 cases.(a-f) Brain CT images of 3 cases showing the site and size of subdural hemorrhage at baseline and changes of SDH after revascularization at day 1. (g-l) Diffusion-weighted imaging (DWI), perfusion-weighted imaging and MR angiography) at baseline showing the salvageable brain tissue with perfusion-diffusion mismatch or MRA-diffusion mismatch. (p-u) The cerebral angiography showing pre-treatment and post-treatment status of occluded vessels. (m-o) The follow-up DWI showing the final infarct volume in 3 cases.

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