# Emergency Mechanical Thrombectomy for Acute Middle Cerebral Artery Occlusion Accompanied by Adult-Onset Still’s Disease

## TL;DR

This paper reports the first case of mechanical thrombectomy in a patient with a rare inflammatory disease called Adult-Onset Still’s Disease who developed a stroke.

## Contribution

The novelty is the first reported use of mechanical thrombectomy for cerebral infarction caused by large vessel occlusion in a patient with AOSD.

## Key findings

- A 60-year-old man with AOSD developed a stroke due to middle cerebral artery occlusion.
- Mechanical thrombectomy successfully restored blood flow in the occluded artery.
- No other source of embolism was found, suggesting AOSD may be linked to embolic strokes.

## Abstract

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory condition of an unknown etiology. Stroke is a rare complication associated with AOSD; most of these are cerebral infarctions due to the occlusion of small blood vessels. Here, we report the first case of mechanical thrombectomy in a patient with cerebral infarction due to a large vessel occlusion associated with AOSD.

A 60-year-old man with no underlying disease was diagnosed with AOSD. Sixteen days after admission, he suddenly lost consciousness and was found to have right hemiplegia and aphasia. Head CT showed early signs of ischemic infarction in the left insular cortex, and head CT angiography demonstrated occlusion in a part of the left middle cerebral artery (MCA). Therefore, we decided that mechanical thrombectomy was an indication of revascularization. We performed mechanical thrombectomy using a Trevo NXT 4 × 28 mm (Stryker, Kalamazoo, USA) and obtained reperfusion of the MCA. The results of the cerebral angiography were indicative of an embolic cerebral infarction, and we investigated the source of the embolism including an insertable cardiac monitor (ICM) (Reveal LINQ, Medtronic, Minneapolis, USA). However, no disease other than AOSD that could be a source of embolism was observed. Therefore, AOSD was assumed to be associated with embolisms.

AOSD may cause embolic cerebral infarction and may be indicated for mechanical thrombectomy.