Delayed M1 Dissection After Thrombectomy Treated With Rescue Stenting and Tirofiban: A Case Report.

Delayed re-occlusion after successful mechanical thrombectomy (MT) is uncommon and often underrecognized. Iatrogenic intracranial arterial dissection represents a rare but potentially devastating mechanism requiring rapid salvage intervention with or without a stent. A 63-year-old woman with a wake-up stroke underwent thrombolysis and MT with complete reperfusion (Thrombolysis in Cerebral Infarction (TICI) grade 3) and full neurological recovery. Three days later, she developed acute neurological deterioration. Angiography demonstrated a right M1 re-occlusion caused by a flow-limiting dissection. Following failed aspiration, emergent rescue stenting with a self-expanding Low-profile Visualized Intraluminal Support (LVIS) EVO stent achieved immediate reperfusion. A tirofiban-based bridging strategy with dual antiplatelet therapy was initiated without hemorrhagic complications. Follow-up imaging showed a small infarct. At 12 months, the patient remained functionally independent, with a modified Rankin Scale (mRS) score of 1 and a National Institutes of Health Stroke Scale (NIHSS) score of 0. Delayed iatrogenic dissection should be suspected in post-thrombectomy deterioration. Rescue intracranial stenting is a definitive and effective salvage strategy, provided that antithrombotic therapy is carefully individualized.