Mechanical Thrombectomy for Large Vessel Occlusions in Cocaine Associated Acute Ischemic Stroke: Small Case Series and Review of the Literature.

Autor: Memon MZ; Department of Neurology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: zeeshanmemon@gmail.com., Kushnirsky M; Department of Neurology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA., Brunet MC; Department of Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA., Siddu M; Department of Neurology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA., Starke RM; Department of Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA., Malik AM; Department of Neurology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA., Koch S; Department of Neurology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA., Yavagal DR; Department of Neurology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2020 Dec; Vol. 29 (12), pp. 105330. Date of Electronic Publication: 2020 Sep 28.
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105330
Abstrakt: Introduction: Cocaine through multifactorial pathogenetic mechanisms causes small and large vessel occlusions (LVO) leading to acute ischemic stroke. The optimal treatment for cocaine related LVO remains unknown. Mechanical thrombectomy (MT) poses a unique challenge, and successful MT are not widely reported.
Material and Methods: We report three patients with no other risk factors and a common history of cocaine metabolites found on presentation drug screen who underwent MT for MCA occlusions with subsequent failed recanalization or vessel re-occlusion due to persistent thrombosis and severe vasospasm.Two patients initially had good revascularization but then developed severe vasospasm and reoccluded, and the remaining patient had persistent severe distal vasospasm. Rescue therapy either with balloon angioplasty with stent placement or intraarterial vasodilator was used in all patients and was ineffective. All patient had large hemispheric strokes and developed malignant cerebral edema requiring hemicraniectomy in two of them. We also did literature review and summarized previously reported cases of cocaine associated vasospasm in MT and other endovascular procedures.
Conclusion: In this case series, cocaine induced vasospasm contributed to unsuccessful recanalization and reocclusion in patients undergoing MT with poor outcomes. Further studies are needed to ascertain strategies for improved outcomes in patients with LVO related to cocaine use.
Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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