Early Recurrent Large Vessel Occlusion After Hemorrhagic Transformation in Newly Diagnosed Atrial Fibrillation: Challenges in Anticoagulation Timing and Repeat Mechanical Thrombectomy

Figures

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  Figure 1. Non-contrast computed tomography (CT scan) No acute intracranial pathology identified; no evidence of intracranial hemorrhage, acute territorial infarction, space-occupying lesion, hydrocephalus, or midline shift.

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  Figure 2. CT cerebral angiogram Initial cerebral angiography demonstrating left M2 middle cerebral artery occlusion (arrowed) prior to mechanical thrombectomy.

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  Figure 3. Post thrombolysis and thrombectomy CT cerebral angiography Cerebral angiography following thrombolysis and initial mechanical thrombectomy demonstrating successful reperfusion of the left middle cerebral artery (circled).

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  Figure 4. Post-thrombolysis and thrombectomy non-contrasted CT brain Post-reperfusion non-contrast CT brain demonstrating focal hemorrhagic transformation within the left middle cerebral artery infarct territory (red circle), without significant mass effect or midline shift.

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  Figure 5. Electrocardiography (ECG) revealed atrial fibrillation ECG obtained during admission demonstrating newly diagnosed atrial fibrillation, considered the likely cardioembolic source of the ischemic stroke.

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  Figure 6. CT cerebral angiography Repeat vascular imaging following recurrent neurological deterioration approximately one week after the index stroke, demonstrating a new left M1 middle cerebral artery occlusion (yellow circle).

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  Figure 7. Post-thrombectomy CT angiogram Post-thrombectomy cerebral angiography demonstrating successful recanalization of the left M1 segment (circled) following repeat mechanical thrombectomy.