Mechanical Thrombectomy for Mild Strokes: How Low Should We Go?

Recorded cases from SLICE 2018

3 october 2018 – 9:20

By Vincent COSTALAT

Hero…or not? When to treat…and when to stop.

An 86-year-old male is seen at a PSC with a right M1 occlusion, an initial NIHSS score of 3 and a DWI Aspects score of 10.

Five hours after the initial stroke alert he is transported to the CSC in Montpellier with an NIHSS score of 4: How would you proceed? Medical management or MT? What would drive your response? Join SLICE course director Prof. Vincent Costalat as he presents a case exploring the “gray zone” not yet covered by any guidelines, where the question of what to do next remains challenging.

Follow his clinical reasoning as the treatment proceeds: Is this patient a “fast progressor”? Can we “just wait”? What elements lead V. Costalat to perform an MT? Why does he describe his approach as similar to that in treating an aneurysm? Would you use general anesthesia (GA) or conscious sedation (CS)? How to manage blood pressure? Would a stress test or CT MAX be useful and how do we judge perfusion? Learn about possible differences observed between the NIHSS scores in the right and left hemispheres and why one is often lower than the other or why judging cognitive function can be difficult. When the situation worsens – the clot appears to move and the first passes fail – what would you do? Continue? But for how long…and why?

Find out what happened, here…

 

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