Early experience with Mechanical Thrombectomy in Kauvery hospital Tirunelveli

Abstract

Background: Acute ischemic stroke due to large vessel occlusion carries high morbidity and mortality, and mechanical thrombectomy (MT) significantly improves outcomes when performed within the appropriate time window. We report the first MT performed at our center in a 61-year-old hypertensive chronic smoker who presented with sudden-onset slurring of speech and left hemiplegia. After receiving intravenous thrombolysis elsewhre and subsequently deteriorating neurologically, he was referred to our centre with an NIHSS score of 16. Imaging revealed a right M1 middle cerebral artery occlusion with an ASPECTS score of 9, good collateral circulation and a large salvageable penumbra. MT was technically challenging due to tortuous iliac arteries, a Type III aortic arch, severe proximal right internal carotid artery stenosis (~90%), and the use of an older-generation angiography system. The first pass with a stent retriever was unsuccessful; a second pass using the Solumbra technique achieved successful TICI 2b reperfusion within 90 minutes. No immediate complications occurred. By post-procedure day 7, the NIHSS improved to 3, and at 30 days the patient demonstrated near-complete functional recovery. This case report highlights technical challenges and clinical outcome.