Mechanical thrombectomy in the pregnant women with hyperacute cerebral infarction

초록

Intravenous thrombolysis and mechanical thrombectomy are appropriate treatments for hyperacute cerebral infarction. But pregnant women were not included in large clinical trials and only several cases have been reported. So, the safety and usefullness of recanalization therapy in these persons remained uncertain. We described a rare case of the patient in the second-trimester, who underwent MT.A 30-year-old woman, in the 25th gestational week of her first pregnancy, visited the emergency room due to sudden left hemiparesis and drowsiness. Initial MR scans showed acute ischemic lesions in right insular and frontal on diffusion-weighted images and total occlusion of right petrous ICA without flow of right MCA from collateral flow. Because of potential risks of recombinant tissue-plasminogen activator, we tried MT alone, using stent retriever and right ICA and MCA were successfully recanalized(TICI IIb) without hemorrhagic conversion. The radiation exposure during endovascular treatment was 647 mGy. She was discharged without serious sequele and was delivered of healthy baby with cesarean section in 38 weeks of gestation.Radiation exposure during endovascular treatment for pregnant woman should be minimized. It is still unclear which mechanical thrombectomy alone or combination of endovascular treatment and intravenous is better treatment option in pregnancy. Our case added the evidence for the feasibility of endovascular treatment in pregnancy even though caution should be taken for publication bias.