Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 17, Number 7, July 2026, pages 356-364

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

Figures

↓  Figure 1. Diffusion-weighted MRI (DWI) demonstrates signal restriction in the right frontal-insular region consistent with acute ischemic stroke. DWI: diffusion-weighted imaging; MRI: magnetic resonance imaging.
Figure 1.
↓  Figure 2. FLAIR MRI demonstrates a right frontal-insular hyperintensity consistent with an ischemic lesion. FLAIR: fluid-attenuated inversion recovery; MRI: magnetic resonance imaging.
Figure 2.
↓  Figure 3. MR angiography demonstrates absence of flow in the right M2 segment of the middle cerebral artery. MR: magnetic resonance.
Figure 3.
↓  Figure 4. Digital subtraction angiography (DSA) confirms complete occlusion of the right superior M2 segment, with absent flow in its vascular territory.
Figure 4.
↓  Figure 5. Digital subtraction angiography (DSA) performed after mechanical thrombectomy demonstrates TICI 2b recanalization of the right superior M2 segment. TICI: Thrombolysis in Cerebral Infarction.
Figure 5.
↓  Figure 6. Diffusion-weighted MRI (DWI) performed 24 h after thrombectomy demonstrates frontal-insular signal restriction, consistent with the evolving infarct, without evidence of new ischemic events during or after the procedure. DWI: diffusion-weighted imaging; MRI: magnetic resonance imaging.
Figure 6.

Table

↓  Table 1. Key Concepts of Treatment
 
AspectKey points
IV: intravenous; tPA: tissue plasminogen activator; CT: computed tomography; BP: blood pressure; CVST: cerebral venous sinus thrombosis; RCVS: reversible cerebral vasoconstriction syndrome.
IncidenceAbout 10–30 per 100,000 pregnancies; highest in peripartum/postpartum
Initial stepImmediate neuroimaging (noncontract CT); do not delay
IV thrombolysis (tPA)Within 4.5 h; pregnancy not absolute contraindication; individualized risk–benefit
Mechanical thrombectomyIndicated for large-vessel occlusion; safe in selected pregnant patients
Anticoagulation (acute phase)Not recommended (increase hemorrhagic transformation risk)
Secondary preventionAntiplatelet therapy after acute phase
Supportive careControl BP, glucose (140–180 mg/dL), normothermia, avoid hypotonic fluids
Special etiologiesManage CVST, dissection, RCVS per standard guidelines
Core principleTreat as standard stroke with pregnancy-specific considerations