Purpose: Early intracranial thrombosis diagnosis is essential for useful intra-arterial thrombectomy.
We use neurological evaluation,
unenhanced computed tomography (CT),
CT angiography associated with perfusion CT and cerebral angiography for main vessels occlusion.
This is moreover important for acute ischemic cryptogenic stroke,
such as patent foramen ovale (PFO) in the immediate postpartum period.
Stroke in pregnancy and puerperium is rare,
serious cause of maternal morbi-mortality.
Methods and Materials
Between May 2010 and May 2012 18 patients (9M,9F),
mean age 50 yo,
underwent endovascular mechanical thrombectomy with Solitaire stent (Covidien) for intracranial thrombosis: 12/18 anterior and 6/18 posterior circulation.
The endovascular procedure was performed under general anesthesia and a double femoral accesses.
Afterwords we have checked the original reason for the acute thrombosis in such young patients and a PFO was diagnosed by TEE (trans esophageal echocardiography).
Technical success was 100%,
with patency restoration in all cases after max 3 stents placements.
4/18 patients developed ischemic or haemorrhagic infarction with slight neurological sequelae; 3/18 patient died after few days due to the extension of ischemic lesion.
1/2 PFO-related stroke had good outcome with small ischemic lesion in basal ganglia (mRankin Scale 0); 1/2 had ischemic lesion within middle cerebral artery territory (mRankin Scale 3).
They both subsequently underwent endovascular...
Endovascular thrombectomy is a recent and innovative procedure that allows to reach good technical and clinical results.
The PFO related cases show that working with a multidisciplinary approach (cardiologist,
interventional radiologist and interventional cardiologist) in the same department can really provide best treatment options even in complex cases.
1_ Curr Treat Options Cardiovasc Med. 2003 Jul;5(3):233-240. Patent Foramen Ovale and Stroke. Rodriguez CJ , Homma S .; Columbia University. 2_ Curr Atheroscler Rep. 2007 Oct;9(4):319-25. Cryptogenic stroke in patients with patent foramen ovale. Saver JL ; UCLA Stroke Center,
Los Angeles. 3_ Cardiol Rev. 2008 Jan-Feb;16(1):53-7. PFO and stroke: what are the data? Wechsler LR ; Department of Neurology,
UPMC Stroke Institute,
University of Pittsburgh Medical School. 4_ Nat Clin Pract...
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