ABSTRACT NUMBER: ESOC2026A2172 A CASE OF EARLY POSTPARTUM ISCHEMIC STROKE: TIMELY THROMBOLYSIS AND THROMBECTOMY FOR RAPID RECOVERY

Abstract Background and aims Postpartum ischemic stroke is rare but associated with significant maternal morbidity. The puerperium represents a transient hypercoagulable state, complicating acute management because of perceived hemorrhagic risk alongside the need for timely reperfusion. Consequently, management often relies on individualized, multidisciplinary decision-making. Methods A 35-year-old woman (gravida 3, para 2) presented to Mater Dei Hospital, Malta, four days after an uncomplicated vaginal delivery with acute left-sided weakness and dysarthria. Neurological examination revealed a National Institutes of Health Stroke Scale (NIHSS) score of 12. Non-contrast CT excluded intracranial hemorrhage, while CT angiography demonstrated an occlusion of the right middle cerebral artery (M1 segment). Following multidisciplinary discussion and informed consent, intravenous thrombolysis with alteplase was administered 90 minutes after symptom onset, resulting in early neurological improvement. Repeat imaging demonstrated distal clot migration to the M2 segment, and mechanical thrombectomy was performed approximately 2.5 hours after presentation, achieving near-complete reperfusion. Results Thrombolysis resulted in early neurological improvement, and thrombectomy achieved near-complete reperfusion. The patient made a full neurological recovery (NIHSS 0) with no hemorrhagic complications. She was discharged home after two days on dual antiplatelet therapy. Thrombophilia screening was unremarkable apart from heterozygosity for the MTHFR C677T variant. Conclusions This case illustrates that intravenous thrombolysis followed by mechanical thrombectomy can be safely and effectively performed in carefully selected patients during the early postpartum period, even shortly after uncomplicated vaginal delivery. It highlights the importance of timely, risk-informed, multidisciplinary decision-making and supports an individualized rather than exclusionary approach to reperfusion therapy in postpartum stroke. Conflict of interest Nothing to disclose