Very Early Treatment of Recurrent Strokes with Mechanical Thrombectomy in a Patient with Severe Anemia

Abstract

Introduction: Recurrent ischemic strokes requiring repeated mechanical thrombectomy (MT) within 24 hours of the initial event are uncommon. This case report describes a 61-year-old woman who underwent two MTs 6 hours apart for ischemic strokes associated with severe anemia due to pure red cell aplasia (PRCA) in different vascular territories.

Case Presentation: The patient, with a history of PRCA presented with left-sided hemiparesis and facial paresis. Neuroimaging revealed a right middle cerebral artery (MCA) M1 segment occlusion. She underwent MT with complete recanalization. Four hours later, new neurological symptoms emerged due to a left MCA occlusion, and a second MT was performed successfully.

Management and Outcome: Alongside MTs, the patient received supportive care, including blood transfusions, analgesics, and anticoagulants. Her neurological status improved significantly two weeks upon discharge with residual left-sided weakness and facial paresis. At 90 days, the patient was able to walk, indicating further functional improvement.

Discussion: This case is notable for the short interval between two MTs and the patient's underlying hematological condition. Severe anemia and PRCA likely contributed to hypercoagulability and increased stroke risk. Despite these unusual risk factors, the patient’s outcome was favorable, which is consistent with the effectiveness of repeated MT for early recurrent ischemic strokes.

Conclusion: Early recurrent stroke in different vascular territories, particularly in the context of hematological disorders, is rare but can be managed effectively with timely MT. Further research is needed to evaluate stroke recurrence risk and therapeutic responses in patients with hematological conditions, including PRCA and severe anemia.

Key words: anemia; ischemic stroke; thrombectomy