Massive cerebral venous sinus thrombosis in vaccine-induced immune thrombotic thrombocytopenia after ChAdOx1 nCoV-19 serum: case report of a successful multidisciplinary approach

Abstract

We report a case of massive cerebral venous sinus thrombosis in the contest of vaccine-induced immune thrombotic thrombocytopenia that required the rapid coordination of many specialists from different departments, notably emergency, neurology, neuroradiology, hematology, and neurosurgery. The patient was rapidly treated with steroids, immunoglobulin, and fondaparinux. She underwent within 6 h after hospital admission a mechanical thrombectomy in order to allow flow restoration in cerebral venous systems. Neuroendovascular treatment in cerebral venous thrombosis related to VITT has never been described before. It can represent a complementary tool along with the other therapies and a multidisciplinary approach.

Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review

“…Of those, 14 records were excluded (because of lack of reported patient data, review articles and registry data without information on individual patients). Eleven records were eligible for analysis ( Table 2 ) [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ], comprising case reports and case series only. Of those, four case reports and case series presented data for four patients with COVID-19 and EVT [ 61 , 62 , 63 , 64 ].…”

“…The first reports of SVT caused by VITT emerged in 2021 [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. As of 20 May 2022, seven records of EVT in 16 VITT patients were identified [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ].…”

“…The first reports of SVT caused by VITT emerged in 2021 [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. As of 20 May 2022, seven records of EVT in 16 VITT patients were identified [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Most cases ( n = 15) were attributed to the ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) vaccine [ 65 , 66 , 67 , 69 , 70 , 71 ].…”

“…As of 20 May 2022, seven records of EVT in 16 VITT patients were identified [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Most cases ( n = 15) were attributed to the ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) vaccine [ 65 , 66 , 67 , 69 , 70 , 71 ]. Only one case appeared to be associated with an mRNA vaccine (mRNA-1273 vaccine; Moderna, Cambridge, MA, USA) [ 68 ].…”

“…Neurological deterioration potentially resulting in poor outcomes facilitated the use of EVT. The technical strategies described were aspiration plus stent retriever or balloon-guided thrombectomy in selected cases [ 65 , 66 , 67 , 69 ]. MRS of 0–1 was observed in seven patients during follow-up [ 65 , 66 , 69 ].…”