Abstract
A 61-year-old female inpatient suddenly experienced right hemiparesis and aphasia. She had known mitral valve stenosis and massive thrombus in the left cardiac atrium. Diffusion weighted MRI disclosed an extensive acute ischemic lesion in the left middle cerebral artery (MCA) territory. Catheter angiography showed occlusion of the left MCA. A Merci Retrieval System removed a few hard organized clots and complete recanalization was obtained about two hours after presentation. Her neurologic deficits resolved rapidly, and most of the ischemic lesion on diffusion weighted MRI disappeared. Cardiac surgery was done, and a large organized clot was removed from the left atrium. For cardiogenic organized clots, fibrinolysis is ineffective. Early recanalization using mechanical clot removal resulted in excellent clinical and radiological outcome in this case.
