2018 Volume 27 Issue 12 Pages 915-920
Several randomized controlled clinical trials conducted in 2015 validated the effectiveness of mechanical thrombectomy for acute ischemic stroke. In Japan, this form of treatment is generally recommended for patients within 8 hours of ischemia onset. Sometimes, however, clinicians are hesitant about deciding the best treatment for patients with so-called “wake-up stroke” or “unknown-onset stroke”. Here we report a case of internal carotid artery occlusion in which neurological recovery was achieved by mechanical thrombectomy performed 18 hours after onset. Notably, in this case there was a mismatch between the findings of diffusion-weighted imaging (DWI)-fluid attenuated IR (FLAIR) and those of MRI. One possible reason could have been a cascade of emboli from a giant clot at the orifice of the internal carotid artery.
This case suggests that mechanical thrombectomy might also be effective for patients with MRI/DWI-FLAIR mismatch, even if diagnosis is delayed for more than 8 hours after onset.
