Sub Acute Right MCA infarct with Chronic left MCA Infarct Carotid Artery Stenting

Clinical Case Report: Carotid Artery Stenting (CAS) for Ischemic Stroke Management in a Year 51 Old Patient from Bangladesh with Sub-acute Right MCA and Chronic Left MCA Infarcts

Findings – The patient suffers from – Sub-acute Hemispheric infarct in the Right MCA and Chronic Hemispheric infarct in the Left MCA.

A hemispheric infarct is a severe type of ischemic stroke (brain attack from a clot) that affects a large portion of one brain hemisphere, often the middle cerebral artery (MCA) territory, causing significant brain swelling (cerebral edema) and high risk of death or severe disability.

A chronic hemispheric infarct is a permanent brain tissue death in one brain half (hemisphere) from a past stroke (ischemic event).

A subacute hemispheric infarct is a stroke that occurred days to weeks prior, affecting one brain hemisphere, appearing on scans (like MRI/CT) as a wedge-shaped area with evolving signs.

We will need to confirm this diagnosis by doing some investigations –

Investigations needed – MRI, DSA, and other routine tests.

A DSA Cerebral Angiogram (Digital Subtraction Angiography) is a specialized X-ray procedure using contrast dye and computer processing to get clear pictures of blood vessels in the brain and neck, diagnosing issues like blockages, aneurysms, or tumours by highlighting blood flow and subtracting bone/tissue.

Possible Line of treatment – For the Left side of the brain, unfortunately, there is only a limited opportunity to survive, but with medical management and rehab, there is a chance that we can revive some functions.

For the right side of the brain, which is now progressively getting damaged, we can recommend a carotid artery stenting procedure, which should help recover a large part of the damaged brain.

Carotid stenting (or Angioplasty and Stenting – CAS) is a minimally invasive procedure to open blocked carotid arteries in the neck, improving blood flow to the brain and preventing strokes. A doctor threads a catheter from the groin to the neck blockage, uses a balloon to widen the artery (angioplasty), and then places a small metal mesh tube (stent) to keep it open, often using a filter to catch debris. It’s an alternative to traditional surgery (endarterectomy) for those at high risk.  

We will recommend the following Neurosurgeons for the patient –

1. Max Healthcare, Gurugram // Dr. Arun Saroha
 Kindly have the virtual tour of the hospital via the link – https://pin.it/2sWwqfts7

2. BLK-Max Super Specialty Hospital, New Delhi // Dr. Anil Kumar Kansal
 Kindly have the virtual tour of the hospital via the link – https://pin.it/1Ji84QapI

3. Artemis Hospital, Gurugram // Dr. Aditya Gupta
 Kindly have the virtual tour of the hospital via the link – https://pin.it/1bs51UAGE

4. Amrita Hospital, Faridabad // Dr. Anandh Balasubramaniam
 Kindly have the virtual tour of the hospital via the link – https://pin.it/6VWWsyyzq

5. Sarvodaya Healthcare, Faridabad // Dr. Yawar Shoaib Ali
 Kindly have the virtual tour of the hospital via the link – https://pin.it/6VWWsyyzq

Estimated cost:

The estimated cost of evaluations will be approx. USD 500-700 on OPD basis.

The estimated cost of DSA will be approx. USD 500-700 on a day care admission.

The Estimated Cost of Surgery (carotid artery stenting) at various hospitals is as below: –

Kindly note: The above rates are on an approximate basis; actual charges will depend upon the final plan confirmed based on medical evaluation at the hospital.

Stay in India: The patient will require 3-5 days for initial evaluations on an OPD basis and will require 4-5 days of hospitalization for surgery. Post-discharge, the patient may require 10-15 days for follow-up and recuperation. Total Length Stay in India will be approx. 3-4 weeks.

Inclusions in the cost:

1. The cost of all investigations related to the surgery (craniotomy and excision)

2. The cost of the treatment.

3. The doctor’s fee and surgery charges.

4. The stay of the patient and 1 attendant during hospital admission.

5. All meals for the patient and the attendant as per the available menu while in hospital.

6. Medical Consumables and Medicines while in hospital.

7. The fee for dietician and nursing while in hospital.

8. It also includes complimentary Airport Transfers, Forex Services, and assistance.

Exclusions:

1. Any consultation other than in discussion.
2. Extended stay
3. Treatment for any other illness

On Arrival: The patient and patient’s attendants will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs.

We shall also assist them with reasonably charged accommodation near the hospital. The patient and attendant may arrange 35-50 USD per day toward accommodation and food at the guest house. 

Hope I have been able to give you a satisfactory answer to the query. Do kindly ask for any clarifications needed. I will be happy to answer & shall look forward to assisting you.

Regards,

Aabhik.