Gadolinium to the rescue for mechanical thrombectomy in acute ischemic stroke. Issue 3 (June 2019)

• Record Type: Journal Article
• Authors: Male, Shailesh; Mehta, Tapan; Tore, Huseyin; Quinn, Coridon; Grande, Andrew W; Tummala, Ramachandra P; Jagadeesan, Bharathi D
• Is Part Of: Interventional neuroradiology. Volume 25:Issue 3(2019:Jun.)
• Page Start: 301
• Page End: 304
• Publication Date: 2019-06
• Subjects: Gadolinium -- stroke -- thrombectomy -- angiogram -- contrast -- allergy; Nervous system -- Interventional radiology -- Periodicals; Nervous system -- Radiography -- Periodicals; Nervous System Diseases -- Periodicals -- radiography; Neuroradiography -- Periodicals; Radiography, Interventional -- Periodicals; Nervous system -- Radiography; Periodicals; 617.4805
• DOI: 10.1177/1591019918815298
• Languages: English
• ISSNs: 1591-0199

Abstract

Introduction: Mechanical thrombectomy in the setting of acute ischemic stroke (AIS) requires cerebral digital subtraction angiography (DSA), typically performed with iodinated contrast medium. We present a case of emergent cerebral DSA and mechanical thrombectomy using gadolinium-based contrast for cerebral DSA in a patient with a history of anaphylaxis to iodinated contrast agents (ICs). Case report: A 72-year-old man developed left ventricle assist device thrombus while on anticoagulation. During hospitalization he suffered right middle cerebral artery occlusion with a National Institutes of Health stroke scale score of 10. He had a history of anaphylaxis and the advanced directives revealed do not resuscitate/do not intubate status. We performed an emergent DSA as part of thrombectomy procedure using gadolinium-based contrast mixed in 1:1 proportion with normal saline. The images obtained were of adequate quality and the patient underwent successful thrombectomy with modified thrombolysis in cerebral infarction 2B recanalization. Conclusion: Gadolinium-based contrast agents could be effective alternatives for cerebral DSA in patients undergoing mechanical thrombectomy for AIS who have a history of anaphylactic reaction to ICs.