C94 Direct mechanical thrombectomy for acute ischaemic stroke in a patient with large frontal meningioma and pulmonary embolism

<h3>Introduction</h3> Thrombolytic therapy is standard in acute ischemic stroke, but intracranial neoplasms pose high hemorrhagic risk. This case illustrates direct mechanical thrombectomy in a patient with stroke, a large frontal meningioma, vasogenic edema, carotid dissection, and bilateral pulmonary emboli. <h3>Case Description</h3> A 59-year-old hypertensive female presented with headache, dyspnea, and sudden aphasia. Initial NIHSS was 2, escalating to 22 in the ED. CT showed a 3.3 cm anterior frontal meningioma with vasogenic edema. CT angiography revealed tapered occlusion of the left carotid artery and non-opacification of the left ICA. CT-PE protocol confirmed bilateral central pulmonary emboli. Given the meningioma and cerebral edema, thrombolysis was contraindicated. Emergent thrombectomy targeted the left M1 and CCA, achieving TICI 2b/3 reperfusion. Despite persistent ICA occlusion, ACA and MCA were patent post-procedure. Neurological status stabilized. Due to bilateral PEs, anticoagulation was initiated with heparin and transitioned to cangrelor. <h3>Conclusions</h3> This case highlights two key insights: Mechanical thrombectomy without thrombolytics was critical. The large meningioma and edema contraindicated IV tPA due to hemorrhagic risk. Successful revascularization demonstrates thrombectomy’s value as a primary therapy in complex neuro-oncologic stroke. Risk-balancing in dual pathology: Although thrombolytics could have benefited the pulmonary emboli, intracranial bleeding risk precluded their use. In patients with concurrent neurovascular and cardiopulmonary threats, therapeutic choices must prioritize safety while preserving efficacy. <h3>Conflict of Interest</h3> No