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(Stroke. 2005;36:e77.)
© 2005 American Heart Association, Inc.

Case Reports

Use of Multimodal MRI and Novel Endovascular Therapies in a Patient Ineligible for Intravenous Tissue Plasminogen Activator

Shuichi Suzuki, MD, PhD; Chelsea S. Kidwell, MD; Sidney Starkman, MD; Jeffrey L. Saver, MD; Gary Duckwiler, MD; Fernando Vinuela, MD Bruce Ovbiagele, MD

From the Department of Radiology (S. Suzuki, G.D., F.V.), Stroke Center and Department of Neurology (C.S.K., S. Starkman, J.L.S., B.O.), and the Department of Emergency Medicine (S. Starkman), UCLA Medical Center, Los Angeles, Calif.

Correspondence to Bruce Ovbiagele, MD, Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095. E-mail ovibes{at}mednet.ucla.edu

Abstract

Background and Purpose— Options are limited for individuals who present to the ED within 3 hours of ischemic stroke onset, but who are deemed ineligible for intravenous thrombolysis. Multimodal MRI has been shown to be of great help in identifying stroke patients with large areas of at risk "penumbral tissue", who may gain from the use of novel endovascular therapies. We report a patient who twice benefited from this management approach, in the setting of hemorrhagic risk following successive ischemic strokes.

Case Description— The patient is a 78 year old male who experienced acute ischemic stroke on 2 separate occasions 5 months apart, and for whom perceived contraindications to appropriate thrombolytic therapy administration led to the successful use of different endovascular therapies at each encounter. Furthermore, following mechanical clot retrieval during the second encounter, the high intensity signal area noted on the baseline diffusion weighted imaging (DWI) in the posterior circulation territory, was almost completely resolved on the day 7 post-procedure MRI.

Conclusion— To our knowledge, this is the first reported case of reversal of a DWI abnormality in the posterior circulation territory.

Key Words: embolectomy • magnetic resonance imaging, diffusion weighted • stroke, acute • thrombectomy • thrombolytic therapy • tissue plasminogen activator