A Case Report Examining a Contraindication for Mechanical Thrombectomy in the Setting of a Large Vessel Occlusion and a Concurrent Contralateral Intracranial Hemorrhage

An acute ischemic stroke occurring contralateral to a hemorrhagic stroke is an uncommon occurrence that presents unique challenges. Hemorrhages have classically been described as a contraindication for mechanical thrombectomy. However, the natural course of a large vessel occlusion with or without decompressive hemicraniectomy is associated with significant morbidity and mortality. This paper investigates the origin of the contraindication for mechanical thrombectomy, the natural history of large vessel occlusion, risks of craniectomy, and risks of mechanical thrombectomy. Given the likelihood of poor outcomes without intervention, mechanical thrombectomy could be considered in select individuals, but future studies into the natural course of contralateral ischemic and hemorrhagic strokes would better guide management.