Document resource
Introduction Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disorder where dilated cardiomyopathy (DCMP) becomes a major cause of morbidity in adulthood. While cardioembolic stroke is a known complication of DCMP, reports of mechanical thrombectomy (MT) in this population are extremely rare. We present a case of a young DMD patient with acute middle cerebral artery (MCA) occlusion successfully treated with MT despite severe left ventricular dysfunction.Case Description A 24-year-old male with Duchenne muscular dystrophy and baseline quadriplegia (Motor Grade 0) presented with sudden onset of dysarthria and left facial palsy. The initial National Institutes of Health Stroke Scale (NIHSS) score was 18.Upon arrival, the patient underwent immediate multimodal magnetic resonance imaging (MRI), including diffusion-weighted (DWI), susceptibility-weighted (SWI), fluid-attenuated inversion recovery (FLAIR), and perfusion-weighted imaging (PWI), along with intracranial and carotid magnetic resonance angiography (MRA). Imaging confirmed an acute cerebral infarction and an occlusion of the right M1 segment of the MCA.Emergent mechanical thrombectomy was performed under general anesthesia. Using an Esperance aspiration catheter, successful recanalization (TICI 2b) was achieved after two aspiration passes. There were no immediate procedural complications.Results Post-procedural echocardiography revealed dilated cardiomyopathy with severe left ventricular dysfunction (Ejection Fraction: 22%) and global hypokinesia. A 72-hour Holter monitoring showed no atrial fibrillation (AF burden 0%). The patient was managed without anticoagulation, given the absence of documented AF or intracardiac thrombus. At discharge, the patient’s NIHSS score was 17; while his dysarthria and facial palsy had improved, the score remained high due to his pre-existing quadriplegia.Conclusion This case demonstrates that mechanical thrombectomy can be a safe and effective treatment for acute large vessel occlusion in patients with DMD, even in the presence of severe cardiomyopathy. Despite the patient’s frailty and low ejection fraction, prompt endovascular intervention led to the resolution of acute stroke symptoms, preventing further neurological decline.Disclosures S. Jin: None.