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3471 Thrombectomy averted stroke: evidence for complete salvageability

bmjno · 2025-10-23 · canonical JSON source

2 visible annotations · policy: published · automated confidence ≥ 75.00%

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Introduction Advances in stroke management are increasingly improving patient outcomes. We present two cases which demonstrate how endovascular thrombectomy can alter tissue fate in ischaemic stroke.Case Descriptions An independent 59-year-old woman presented with acute left-sided facial droop and slurred speech with a NIHSS of 11. CT perfusion (CTP) imaging showed a right middle cerebral artery (MCA) deficit, with an abrupt cut off in the right M2 segment on CT angiography. She was thrombolysed, after which she underwent EVT within three hours of symptom onset. On re-assessment 24 hours later her NIHSS was 0. Four days following her presentation she underwent magnetic resonance imaging (MRI), which did not demonstrate any diffusion restriction to indicate acute infarction. Similarly, an independent 77-year-old woman presented with sudden onset left sided facial droop and aphasia, with a NIHSS of three. CTP demonstrated a small core with a large penumbra. She underwent thrombectomy to remove a distal right M1 segment clot within three and a half hours of symptom onset. At 24 hours, her symptoms had resolved. MRI performed on day three did not show any evidence of an acute infarct.Conclusion Averted ischaemic stroke has previously been described in the literature, however not in the context of thrombectomy. These two cases support the concept of CTP core being only an estimate of tissue destined to infarction that is potentially salvageable with fast and effective recanalization.