Endovascular Thrombectomy in a Young Female Patient With Atrial Septal Defect: A Case Report

Area of Science:

• Neurology
• Cardiology
• Vascular Medicine

Background:

• Large vessel occlusion (LVO) strokes are rare in patients under 30, often presenting with stroke mimics that delay diagnosis and treatment.
• Younger patients with stroke symptoms require careful evaluation to differentiate from conditions like autoimmune neuropathy or medication side effects (e.g., oral contraceptives for migraine).

Observation:

• A 26-year-old female with a history of migraine and depression presented with paralysis, found to have right middle cerebral artery occlusion.
• She had been using oral contraceptives and had elevated D-dimer levels; stroke risk factors were otherwise unclear.
• Transesophageal echocardiography revealed an atrial septal defect (ASD), suggesting a paradoxical embolism as the stroke mechanism.

Findings:

• Successful mechanical thrombectomy achieved Thrombolysis in Cerebral Infarction (TICI) 3 status, with the patient discharged neurologically intact.
• Diagnosis of paradoxical embolism via ASD was confirmed, and treatment included anticoagulation and planned ASD closure.
• This case highlights the importance of considering LVO in young individuals, even with pre-existing conditions or risk factors like oral contraceptive use.

Implications:

• Clinicians must maintain a high index of suspicion for LVO in young patients presenting with stroke-like symptoms, considering diverse etiologies.
• The case underscores the need for cautious prescription of oral contraceptives in migraine patients due to potential ischemic stroke risk.
• Early diagnosis and intervention, including mechanical thrombectomy and addressing underlying causes like ASD, are crucial for favorable outcomes in young LVO patients.