# Endovascular treatment without postoperative decompressive craniectomy in an acute stroke patient with very large ischemic infarct core: A case report and literature review

## TL;DR

A patient with a very large stroke brain injury recovered well after a specific treatment without needing a craniectomy.

## Contribution

Demonstrates successful endovascular treatment in a stroke patient with a very large ischemic core without decompressive craniectomy.

## Key findings

- A patient with a 190 ml ischemic core achieved functional independence after EVT.
- A mismatch ratio of 1.9 suggested salvageable brain tissue despite large infarct core.
- Younger age and functional area mismatch may make aggressive EVT beneficial in such cases.

## Abstract

The benefits of endovascular treatment (EVT) on large ischemic infarct core mainly focus on a core size of 70–150 ml. The relationship between EVT and very large ischemic infarct core (>150 ml) is unclear. We herein present an acute stroke patient who achieved functional independence after EVT without postoperative decompressive craniectomy despite very large ischemic infarct core.

A 50-year-old Asian male was admitted to our hospital with “sudden disturbance of consciousness with left limb weakness for 11 hours”. The patient had a history of clipping treatment for ruptured aneurysms. After an emergency CTA and CTP, very large ischemic core of 190 ml and a mismatch ratio (Tmax > 6s volume/core volume) of 1.9 were shown in preoperative imaging. EVT was performed, and postoperative strict monitoring was conducted without decompressive craniectomy. The patient was discharged from the hospital on the 16th day, scoring 2 on the modified Rankin scale at a 2-year follow-up.

Imaging suggests very large ischemic infarct core; if there is a substantial mismatch between major functional areas (large ischemic penumbra) and the patient is relatively young, aggressive EVT may be beneficial.