140 https://www.id-press.eu/mjms/index Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2020 Oct 03; 8(C):140-145. https://doi.org/10.3889/oamjms.2020.4827 eISSN: 1857-9655 Category: C - Case Reports Section: Case Report in Internal Medicine Symptomatic Intracerebral Hemorrhage Complicating Intra-Arterial Mechanical Thrombectomy in Acute Ischemic Stroke Muhammad Yunus Amran*, Ashari Bahar Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University. Brain Centre, Dr. Wahidin Sudirohusodo General Hospital and Hasanuddin University Teaching Hospital. Jl. Perintis Kemerdekaan KM 11, Makassar, South Sulawesi, 90245, Indonesia Abstract BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. The endovascular treatment of AIS depends on stroke subtype, whether caused by large vessel occlusion (LVO) or not. We presented a case of AIS due to LVO that has complication in the form of symptomatic intracerebral hemorrhage (sICH) after an intra-arterial mechanical thrombectomy. CASE PRESENTATION: An 80-year-old woman was admitted to the emergency department with sudden onset left side weakness since <1 h before admission, when the patient had woke up in the morning. The patient had history of hypertension, diabetes mellitus, and dyslipidemia. She also had cardiac disorders in the form of non-valvular atrial fbrillation with 55% left ventricular ejection fraction (LVEF). Her blood pressure was 148/84 mmHg, heart rate was 65 beats/minute, respiratory rate was 17 times/min, and body temperature was 36.2°C. Glasgow coma scale (GCS) was E3V4M5; National Institutes of Health Stroke Scale (NIHSS) was 15. She had moderate aphasia. Head CT scan did not show any hyper- or hypodens areas and Alberta Stroke Program Early CT score was 10. RAPID automated CT perfusion using Quantitative Software showed that the mismatch volume was 192 ml and the mismatch ratio was 7.4. Endovascular therapy in the form of intra-arterial mechanical thrombectomy was performed, and blood fow in the right internal carotid artery (ICA) was restored with the score of Modifed Thrombolysis in Cerebral Infarction (mTICI) was III. Follow-up non-contrast head CT scan was performed and revealed acute infarction with hemorrhagic transformation in the middle cerebral artery (MCA) territory. CONCLUSION: Early and accurate treatment of AIS is paramount. Endovascular treatment in the form of intra- arterial mechanical thrombectomy is the current treatment recommendation in LVO although there is a risk of symptomatic intracerebral hemorrhage, as in this case. Edited by: Ksenija Bogoeva-Kostovska Citation: Amran MY, Bahar A. Symptomatic Intracerebral Hemorrhage Complicating Intra-Arterial Mechanical Thrombectomy in Acute Ischemic Stroke. Open Access Maced J Med Sci. 2020 Oct 03; 8(C):140-145. https://doi.org/10.3889/oamjms.2020.4827 Keywords: Acute ischemic stroke; rtPA IV; Intra-arterial mechanical thrombectomy; Large vessel occlusion *Correspondence: Muhammad Yunus Amran, Department of Neurology, Faculty of Medicine, Hasanuddin University. Brain Centre, Dr. Wahidin Sudirohusodo General Hospital and Hasanuddin University Teaching Hospital. Jl. Perintis Kemerdekaan KM 11, Makassar, South Sulawesi, 90245, Indonesia. E-mail: yunusamran10@gmail.com Received: 23-Apr-2020 Revised: 19-Sep-2020 Accepted: 23-Sep-2020 Copyright: © 2020 Muhammad Yunus Amran, Ashari Bahar Funding: This research did not receive any fnancial support Competing Interests: The authors have declared that no competing interests exist. Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Cerebrovascular disease/stroke is a major health problem and the leading cause of death and disability in the world and in Indonesia. Based on RISKESDAS 2018, there has been an increase in the prevalence of stroke (permil) in Indonesian population aged ≥ 15 years, in 2013–2018 from 7% to 10.9% [1], [2]. Acute ischemic stroke (AIS) is the most common type of stroke with high rate of disability and death [3], [4]. The management of AIS has evolved since the past 20 years. The principle treatment of AIS is intravenous recombinant tissue plasminogen activator (rt-PA) and endovascular therapy using several catheter- based treatment systems [5], [6], [7], [8]. Endovascular treatment of AIS uses minimally invasive protocol with catheter placement through femoral artery puncture. This procedure has several complications, which can potentially worsen the patient’s outcome. Complication can be caused by catheter manipulation, micro-wire, and the use of several thrombectomy devices which can damage to the endothelial lining of the cerebral artery. It may also be caused by the presence of micro emboli that are released when an endovascular handler is performed. In this case report, we reported a case of AIS that was treated with intra-arterial thrombectomy (IAT) using several thrombectomy devices with the results of modifed thrombolysis in cerebral infarction (mTICI) 3. However, 1 day after IAT the patient developed intracranial hemorrhage in the right middle cerebral artery (MCA) infarction. Case Report An 80-year-old woman was admitted to the emergency department with complaints of weakness in the left side of her body since less than an hour before admitted. The weakness was developed suddenly after she woke up in the morning. The patient also complained left facial cramp. She had history of hypertension, diabetes mellitus, and dyslipidemia. She also had history of non-valvular atrial fbrillation with left ventricular