Mechanical thrombectomy (MT) in large core ischaemic stroke – clinical cases and reflections

Marigold, R, Weir, N., Mavrokordatos, C., Evans, S., Battersby Wood, E., Crawford, P. and Tjerkstra, E (2025) Mechanical thrombectomy (MT) in large core ischaemic stroke – clinical cases and reflections. International Journal of Stroke, 20 (3S), 106. (doi:10.1177/17474930251379781).

Abstract

Introduction: Several clinical trials (SELECT 2, RESCUE Japan LIMIT,
and ANGEL ASPECT) have shown benefits of MT in patients with large
core ischaemic strokes and the MAGNA individual patient data metaanalysis
showed a consistent benefit of MT with ASPECTS 3-5. We present
2 cases and discuss the outcomes.

Method:
An 80 year old developed a right hemiparesis, aphasia, and
hemianopia, NIHSS 26. CT/CTA/CTP showed early ischaemic changes
with an ASPECTS 4, a tandem left ICA occlusion, and CBF<30% volume
34ml and Tmax>6.0s volume 92ml. She underwent MT, post procedure
NIHSS 8. She had ongoing dysphasia and neglect but was mobile with
assistance and discharged home with a care package

A 48 year old man presented to his local hospital with a dense left hemiparesis,
hemisensory inattention, neglect, hemianopia and NIHSS 17. CT/
CTA showed an ASPECTS 5, and posterior branch right MCA occlusion.
He underwent MT 12hrs post symptom onset. 24hr NIHSS 9, with
improvements in weakness and neglect and repatriated to his local
hospital.

Results or details of the case: These two cases provide clear demonstration
of an early reduction in NIHSS score and reduced neurological
symptom burden having had a MT.

Conclusion: MT for large core ischaemic stroke results in a reduction in
neurological disability and should be considered for patients with
ASPECTS 3-5 and a CTP mismatch of >15ml. We discuss our experience
with two illustrative cases and the implications for our service.

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