Beating the Clock - Successful Thrombectomy 28 Hours After Stroke in a Young Adult With Internal Carotid Artery Dissection

Sep 30, 2026

Stroke poses a major diagnostic challenge in young adults, where causes can differ from older populations; arterial dissection is a key contributor leading to large-vessel occlusion and neurological deficits. Mechanical thrombectomy has improved outcomes, typically within defined time windows, but modern neuroimaging enables extended selection by identifying salvageable brain tissue. This case describes delayed presentation after internal carotid artery dissection with successful revascularisation and strong early recovery.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

Introduction

Case Presentation

How to cite this article

Review began 11/02/2025 Review ended 11/30/2025 Published 12/08/2025 © Copyright 2025 Qureshi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98724 Open Access Case Report Beating the Clock: Successful Thrombectomy 28 Hours After Stroke in a Young Adult With Internal Carotid Artery Dissection Bushra Qureshi 1, Sobiya Farook 2, Mohammadzakir Diwan 3, Sheeba Philip 4 1. Department of Geriatrics, East Lancashire Hospitals NHS Trust, Blackburn, GBR 2. Department of Emergency Medicine, East Lancashire Hospitals NHS Trust, Blackburn, GBR 3. Department of Internal Medicine, East Lancashire Hospitals NHS Trust, Blackburn, GBR 4. Department of Neurology, East Lancashire Hospitals NHS Trust, Blackburn, GBR Corresponding author: Bushra Qureshi, [bushra.qureshi@elht.nhs.uk](bushra.qureshi@elht.nhs.uk) Abstract Stroke is a significant diagnostic challenge in the young population. Aortic dissection is a prominent cause, among many other aetiologies, leading to subsequent neurological deficits as a result of large vessel occlusion. Neurological thrombectomy has revolutionised the management of stroke. Current clinical guidelines recommend thrombectomy within a defined time window after symptom onset. However, with advancements in modern medicine and neuroimaging, patient selection can now extend beyond the traditional time windows by identifying salvageable brain tissue. We present the case of a young man who experienced a fall and suffered a transient loss of consciousness. He went to sleep and subsequently woke up with left-sided weakness and speech disturbances. A CT scan of the head was performed, which showed a right-sided infarct. A CT angiogram showed a right internal carotid artery (ICA) dissection complicated by occlusion of the middle cerebral artery (MCA) . A CT perfusion scan highlighted a large ischaemic penumbra with a small relative infarct core, well beyond the usual therapeutic window. Given the clinical status and favourable imaging profile, even though the patient had passed the thrombectomy window, the patient underwent a mechanical thrombectomy (approximately 28 hours post onset) . The procedure resulted in successful revascularisation, and there was profound neurological recovery, which was reflected in a modified Rankin Scale score (mRS) of 1 and a National Institutes of Health Stroke Scale (NIHSS) score of 1, consistent with marked clinical recovery at the time of discharge. This case shows the importance of advanced imaging in guiding treatment decisions for patients with delayed presentation of ischaemic stroke. It underlines the significance of arterial dissection in a younger age group presenting with stroke symptoms. A thrombectomy beyond the usual norm may be a viable and effective treatment option when carefully selected in specific patients. Categories: Neurology, Radiology, Emergency Medicine Keywords: acute ischaemic stroke, ct brain perfusion, internal carotid artery occlusion, stroke, stroke in young patients, stroke thrombectomy Introduction An immense diagnostic and therapeutic challenge is posed by ischaemic stroke, especially in the younger age group. Unlike in older populations, the aetiologies differ, with arterial dissection accounting for a substantial proportion of cases [1] . A well-recognised cause of ischaemic stroke is internal carotid artery (ICA) dissection, frequently resulting in neurological deficits due to large-vessel occlusion (LVO) [1] . The advent of mechanical thrombectomy has dramatically improved outcomes, particularly in LVO strokes treated within six hours of symptom onset [2, 3]. Landmark trials such as DAWN (Diffusion Weighted Imaging or CT Perfusion Assessment With Clinical Mismatch in the Triage of Wake-Up a

FAQs

Why is diagnosing stroke in young adults challenging?

The article notes that stroke in younger patients has different aetiologies than older populations, making the diagnostic process more complex.

What imaging findings supported thrombectomy beyond the usual time window?

CT angiography identified a right internal carotid artery dissection with MCA occlusion, while CT perfusion showed a large ischaemic penumbra with a small infarct core, indicating salvageable tissue despite delay.

What was the outcome after the mechanical thrombectomy performed about 28 hours after onset?

The procedure achieved successful revascularisation and the patient showed profound neurological recovery, reflected by mRS of 1 and NIHSS of 1 at discharge.

Sep 30, 2026

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