Extended window thrombectomy st 12hrs in a 47 year old man with aspects 5, and significant improvement In NIHSS using CT/CTA

Marigold, R., Siddegowda, P., Macdonald, J. and Marigold, R. (2024) Extended window thrombectomy st 12hrs in a 47 year old man with aspects 5, and significant improvement In NIHSS using CT/CTA. International Journal of Stroke, 19 (1), 6-6. (doi:10.1177/17474930241228206).

Abstract

Introduction: A Number Of Clinical Trials Have Shown Improvements In Outcome In Extended Window Thrombectomy Using Simpler Imaging Paradigms Such As Ct And Ct Angiography Rather Than Perfusion Imaging. We Describe Such A Case Who Presented To Our Service.

Method: A 47 Year Old Man Was Last Seen Well At 9Pm The Previous Evening. He Fell Out Of Bed At 3Am, Went To Work And At 10Am, Was Not Using Right Words Or Able To Use His Phone, And Attended The Emergency Department In Winchester. He Was Found To Have An Nihss 17 With A Dense Left Hemiparesis, Neglect, Inattention, And Dysarthria. A Non Contrast Ct Brain Showed A Right Middle Cerebral Artery Infarction With An Aspects Score Of 5. He Had A Ct Angiogram Which Showed A Right Mca M2 Posterior Branch Occlusion.

Results: He Was Transferred To University Hospital Southampton Where He Had A Mechanical Thrombectomy At 15:35, Approximately 12Hrs After He Had Fallen Out Of Bed.The Following Morning He Had Significantly Improved, With Some Mild Left Arm And Leg Weakness And Sensory Neglect. His Repeat Nihss Score Was 6.

Conclusion: Recent Clinical Trials And 2023 Uk National Clinical Guidelines For Stroke Support Extended Window Thrombectomy Up To 12 Hours Using Ct And Ct Angiography, Including In Patients With An Aspects Score 3-5. This Case Demonstrates A Good Outcome In Accordance With These Recent Changes In The Evidence

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