2021 Volume 43 Issue 1 Pages 31-36
A 77-year-old male presented with sudden onset right hemiparalysis and total aphasia. The National Institutes of Health Stroke Scale (NIHSS) score was 17 and the magnetic resonance angiography (MRA) showed occlusion in the distal M1 segment of the left middle cerebral artery. The diffusion weighted image (DWI) revealed early ischemic change in the corresponding MRA field with DWI -Alberta Stroke Program Early CT Score (DWI-ASPECTS) of 8. White blood cell count and CRP levels were elevated; however, electrocardiogram did not show atrial fibrillation. The final diagnosis was acute cerebral infarction. We performed mechanical thrombectomy after injection of intravenous recombinant tissue plasminogen activator (rt-PA). The procedure was successful in four passes, attaining Thrombolysis in Cerebral Infarction (TICI) Grade 2b recanalization. Based on pathological and bacteriological examinations of the retrieved emboli, acute cerebral infarction was attributed to infective endocarditis (IE). Antibiotic therapy was initiated; antithrombotic therapy was not given. The patient was transferred to a rehabilitation hospital with modified Rankin Scale (mRS) of 4. There was no recurrence of cerebral infarction during follow-up. Mechanical thrombectomy for the large vessel occlusion due to IE tends to require more passes, and the choice of thrombectomy device, aspiration or stent retriever, is still debated because IE embolus composition differs from usual thrombi. However, pathological and bacteriological diagnosis of emboli may be useful for the choice of post-therapy.
