Life-Saving Intracranial Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy: Balancing Maternal and Fetal Risk

Abstract

Stroke during pregnancy is uncommon but poses a significant threat to both mother and fetus, requiring rapid, carefully balanced interventions. We describe a 46-year-old woman at 24 weeks’ gestation who presented with sudden speech difficulties, facial droop, and weakness on one side of her body. Imaging revealed an acute right middle cerebral artery occlusion, and extensive evaluation ruled out cardioembolic, thrombophilia, and vascular causes. She underwent urgent mechanical thrombectomy under monitored anesthesia care, achieving partial revascularization without complications. Her neurological function improved progressively, and both maternal and fetal outcomes were favorable. This case highlights the complexity of managing acute stroke in pregnancy, where timely decision-making must integrate standard stroke protocols with pregnancy-specific considerations, including imaging, anesthesia, and multidisciplinary care. Sharing such experiences is essential to expand knowledge on the safety and effectiveness of endovascular interventions in this rare but critical setting.