Perfusion image guided mechanical thrombectomy combined with tirofiban successfully revascularize systemic lupus erythematosus related acute large vessel occlusion

Abstract

Rationale: Systemic lupus erythematosus (SLE) is an important cause of stroke, more than a half the cases present as acute ischemic stroke. Thrombolysis is an effective choice in most cases, but for large vessel occlusion, mechanical thrombectomy is more effective. Here we reported a case of SLE-related stroke with left middle cerebral artery (MCA) occlusion, who was successfully treated by MT and tirofiban. Patient concern: A 38-year-old female suffered from right hemiplegia and aphasia for 8 hours. She was diagnosed with SLE 20 years ago, and neuropsychiatric SLE was considered 8 months before this onset. One month ago, glucocorticoids were discontinued by herself because of deterioration of bilateral femoral head osteonecrosis. Diagnosis: Left MCA occlusion was confirmed by computed tomography perfusion. Intervention: Immediate mechanical thrombectomy was performed and tirofiban was given to prevent re-occlusion of left MCA. Twenty fourhours later oral antiplatelet was given after intracranial hemorrhage was ruled out. Outcomes: Her neurological symptom improved several days later, and she was transferred to further rehabilitation. At 4 months follow-up she can live independently with mild hypophrasia. There was no further events of ischemic stroke in 1-year follow-up. Lessons: Mechanical thrombectomy is a highly effective and indispensable treatment for SLE related large vessel occlusion. In addition, tirofiban may reduce vessel reocclusion in special cases such as SLE and artery stenosis.

Emergency Revascularization for Acute Vertebral Artery Occlusion Accompanied by Systemic Lupus Erythematosus: A Case Report

“…Only two cases of MT for cerebral infarction in patients with SLE have been reported, and there have been no reports of PTA and stenting, as in this case (Table 2) [1,6]. The mechanisms underlying cerebral infarction in patients with SLE are assumed to be endocarditis, autoimmune-mediated vasculitis, inflammation-mediated atherosclerosis, or blood hypercoagulability secondary to antiphospholipid antibody (aPL) emergence [7,8].…”

“…Furthermore, individuals with SLE have a lower rate of survival after stroke than the general population [ 5 ]. Only two cases of MT for cerebral infarction in patients with SLE have been reported, and there have been no reports of PTA and stenting, as in this case (Table 2 ) [ 1 , 6 ].…”

“…Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by systemic inflammatory lesions caused by the deposition of immune complexes, such as anti-DNA antibodies, in tissues. It is an important cause of stroke, whose prevalence among patients with SLE is 3.1% and incidence is 1.25 per 1000 annually; more than half of these cases are acute ischemic stroke (AIS)[ 1 ].…”

Young mother with lupus and life-altering cardiocerebrovascular nightmare: a case report

“… 13 However, no guidelines exist for treating patients with SLE with recent MI, LV thrombus, or acute embolic stroke, and only a few cases have reported the use of thrombolysis 13 , 14 or mechanical thrombectomy. 15 , 16 Considering the reperfusion injury risk and recent bleeding episodes, the multi-disciplinary team discussion with the patient’s family decided not to proceed with either treatment.…”