Rise and restore: the role of cerebral angiogram with mechanical thrombectomy in the case of cerebral vascular accident and a wake-up stroke: a case report

Background: Intravenous thrombolytic therapy with tissue plasminogen activators (that is, tenecteplase, alteplase) and mechanical thrombectomy are both considered standard treatments for acute ischemic stroke, with mechanical thrombectomy being the gold standard for large vessel occlusions. Mechanical thrombectomy is a minimally invasive procedure that is increasingly considered a gold standard for treating ischemic strokes caused by large vessel occlusions, offering a less invasive alternative to traditional surgical options while minimizing vascular and epidermal risks. Case presentation: A 45-year-old American male presented with aphasia and right-sided weakness for an unknown time, secondary to a wake-up stroke, was subsequently diagnosed with a cerebral vascular accident and underwent a mechanical thrombectomy. Considering that a large vessel ischemic stroke has a greater risk of poor prognosis, the level of recovery seen in our patient highlights what has been shown in recent trials, namely that expansion of mechanical thrombectomy indications in large-core patients can have a meaningful impact, as up to a third of patients can be functionally independent at 90 days. In our patient’s case, he only needed about 96 hours before he was able to go home to his wife and two children. Also, given the large stroke and bearing in mind the risks versus benefits, the decision was made not to be overly aggressive and stent the dissection, as it was not re-occluding and flow-limiting, as this would require dual anti-platelet medications which would have increased the risk of bleeding. Conclusion: This case highlights that effective management requires not only understanding available therapeutic options but also knowing when their application is most appropriate, regardless of the level of invasiveness. This principle is central to optimizing patient outcomes and exemplifies the thoughtful application of clinical judgment—in the words of a colleague: “the art of practicing medicine.”