A woman in her 70s with a history of atrial fibrillation presented with slurred speech and difficulty ambulating for 1 hour. Neurologic evaluation revealed dense left-sided hemiplegia, forced right gaze deviation, left facial droop, complete hemianopia, and severe dysarthria. Computed tomographic angiography identified an occlusive thrombus in the proximal segment of the right middle cerebral artery without intracerebral hemorrhage. Her international normalized ratio was less than 1.5. She was treated with intravenous thrombolysis and then taken for endovascular therapy. Multiple attempts to recanalize the vasculature using stent retrievers and aspiration devices were unsuccessful; only the proximal portion of the M1 segment of the middle cerebral artery was recanalized along with the lenticulostriate perforators.
Alqahtani SA, Leigh R. Imaging Active Intracerebral Hemorrhage After Attempted Endovascular Thrombectomy. JAMA Neurol. 2016;73(6):754. doi:10.1001/jamaneurol.2016.0570