Recurrent ischemic stroke treated with mechanical thrombectomy during a pregnancy: a case report

Background: Although the evidence from large randomized controlled trials confirmed that mechanical thrombectomy is effective in selected patients with an intracranial proximal artery occlusion, pregnancy was excluded from the study protocols. The described case depicts an endovascular treatment of recurrent acute ischemic stroke in pregnancy.     

Case report: A 19-year-old woman during her 12th gestational week was admitted to our comprehensive stroke center suffering from acute ischemic stroke within the territory of left internal carotid artery. The National Institute of Health Stroke Scale (NIHSS) during admission was 17. She had a history of aneurysmal subarachnoid hemorrhage, endocarditis 4 years ago and ischemic stroke with occlusion of M2 segment of left middle cerebral artery (MCA) successfully treated with mechanical thrombectomy (at discharge NIHSS 0) seventeen days before recent stroke.
The urgent MRI at our hospital showed an acute and subacute ischemic lesion involving the left basal ganglia and the occlusion of M1 segment of left MCA. Due to her above mentioned history, she was treated with mechanical thrombectomy alone using stent retriever. Complete recanalization was achieved with no evidence of hemorrhagic transformation on control MRI. Transesophageal echocardiography identified thrombus in left ventricular outflow tract. The patient was discharged with NIHSS 0 and received anticoagulation therapy.

Conclusion: Mechanical thrombectomy (even doubled within the 17 days apart) was, in this case, feasible and successful and might be considered as option for treatment of sever ischemic stroke with M1 or M2 occlusion in pregnancy.

RECURRENT ISCHEMIC STROKE TREATED WITH MECHANICAL THROMBECTOMY DURING A PREGNANCY: A CASE REPORT