Journal Article

C118 Dejavu mechanical thrombectomy in medium vessel occlusion at same location in a patient with severe mitral stenosis and warfarin resistance: a case report

Pai Pavan

2025

Overview

IntroductionMedium vessel occlusion (MeVO) mechanical thrombectomy (MT) has enhanced the scope of eligibility for the procedure. We study a patient with Mitral Stenosis (MS) and Warfarin resistance who underwent MT in MeVO twice at same location in a span of 1.5 years with DWI negative stroke second time and recovered completely with TICI3 recanalisation twice.Case DescriptionA 54 year old lady with severe MS on Warfarin presented with an acute onset right leg weakness with aphasia of three hours duration on 29/12/2022. MRA brain showed left ACA territory infarct with left A2 occlusion. Her INR was 1.3 hence thrombolysed with Inj Tenecteplase 14 mg. Her cerebral DSA showed MeVO at the bifurcation of left ACA A2 segment into Pericallosal and callosomarginal arteries. MT was performed using 0.062’ Red aspiration catheter using ADAPT technique resulting in TICI3 recanalisation after first pass.The same patient on 10/07/2024 again presented with Right leg weakness and aphasia of one hour duration with NIHSS 8. MRA brain did not show acute infarct. However, considering past history of similar presentation and subtherapeutic INR patient was taken for direct MT which showed thrombus at same location. Hence repeat MT was performed using same device and patient once again recovered with TICI 3 recanalisation.ConclusionsRepeat (Dejavu) MT of MeVO at same location with DWI negative stroke in a patient with severe MS and Warfarin resistance and patient recovering twice is once in a lifetime occurrence. Patient has been advised Mitral Valve Replacement at the earliest to prevent future stroke.Conflict of InterestNo

• Publisher: BMJ Publishing Group LTD
• Subject: Aphasia