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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Emergency microsurgical embolectomy in acute ischemic stroke with diffusion-negative MRI
Ki Seong Eom1, Daw Won Kim1, Sungdon Kang1
1Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Republic of Korea.
Neurologia I Neurochirurgia Polska
|December 15, 2015
Summary
Diffusion-weighted imaging (DWI) can miss acute stroke cases, as seen in a patient with a false-negative DWI. Microsurgical embolectomy proved effective when mechanical methods failed due to artery structure.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Diffusion-weighted imaging (DWI) is a primary tool for detecting acute ischemic stroke.
- However, instances of false-negative DWI results in acute stroke are increasingly reported.
- Middle cerebral artery (MCA) occlusion is a common cause of severe ischemic stroke.
Observation:
- A 64-year-old woman presented with symptoms suggestive of acute ischemic stroke.
- Initial diffusion-weighted imaging (DWI) did not reveal evidence of acute infarction.
- The patient underwent emergency microsurgical embolectomy for a middle cerebral artery (MCA) occlusion after endovascular mechanical embolectomy failed.
Findings:
- The microsurgical embolectomy successfully treated the MCA occlusion.
- This case highlights a false-negative DWI in the context of acute ischemic stroke.
- Microsurgical embolectomy was successful where mechanical embolectomy was not feasible.
Implications:
- Microsurgical embolectomy should be considered a viable treatment option for acute ischemic stroke, particularly when mechanical approaches are limited.
- Complex vascular anatomy, such as tortuous vessels, may preclude successful mechanical catheterization.
- Accurate diagnosis and timely intervention are crucial for managing acute ischemic stroke, even with challenging imaging findings.
