Post-Ablation Stroke Despite NOAC Use: Successful Reperfusion Therapy After Dabigatran Reversal with Incidental Discovery of a Large MCA Aneurysm-A Case Report
Case report published in Neurology international (2025)
Abstract
Background: Catheter ablation is an established rhythm-control strategy for atrial fibrillation (AF), yet peri-procedural embolic stroke may still occur despite uninterrupted NOAC therapy. Case presentation: A 49-year-old woman on dabigatran developed acute ischemic stroke three days after AF ablation, presenting with left hemiparesis and dysarthria. Idarucizumab (5 g) enabled safe intravenous thrombolysis followed by emergency endovascular thrombectomy (EVT), achieving complete recanalization (mTICI 3). Angiography revealed an incidental 7 mm right MCA aneurysm at the occlusion site. Dabigatran was resumed on day 4, and one month later, the aneurysm was successfully treated with stent-assisted coil embolization. She remained asymptomatic at two months. Conclusions: This case illustrates how idarucizumab reversal expands reperfusion options by enabling both IVT and EVT in NOAC-treated patients and highlights the diagnostic role of EVT in revealing underlying vascular pathology, emphasizing the need for individualized post-procedural antithrombotic management.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Catheter ablation is an established rhythm-control strategy for atrial fibrillation (AF), yet peri-procedural embolic stroke may still occur despite uninterrupted NOAC therapy.A 49-year-old woman on dabigatran developed acute ischemic stroke three days after AF ablation, presenting with left hemiparesis and dysarthria.
Por qué esto importa para la hirudoterapia
Este caso clínico describe a una mujer de 49 años en tratamiento con dabigatrán que presentó un accidente cerebrovascular isquémico agudo tres días después de una ablación por fibrilación auricular y fue tratada con éxito mediante trombólisis intravenosa y trombectomía endovascular tras la reversión con idarucizumab, logrando recanalización completa. El caso ilustra cómo la reversión con idarucizumab amplía las opciones de reperfusión al permitir tanto la intervención intravenosa como la endovascular. El resumen no menciona sanguijuelas, hirudina, hirudoterapia ni el secretoma de la sanguijuela. Como caso clínico único centrado en la reversión de un anticoagulante farmacéutico para facilitar la terapia de reperfusión en el ictus, su relevancia para la American Society of Hirudotherapy es insignificante y completamente indirecta.
Citación
Post-Ablation Stroke Despite NOAC Use: Successful Reperfusion Therapy After Dabigatran Reversal with Incidental Discovery of a Large MCA Aneurysm-A Case Report
Sari SM et al. · Neurology international, 2025
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026