Therapeutic challenges after successful thrombectomy in a patient with an antiphospholipid syndrome associated M1-occlusion: A case report

Abstract

<jats:sec><jats:title>Backround</jats:title><jats:p> Stroke is a frequent disorder in patients with an antiphospholipid syndrome (APS). Due to a high risk for further thromboembolic events, appropriate anticoagulation therapy in patients with an APS-associated stroke seems mandatory but drug eluting and duration is a matter of debate. </jats:p></jats:sec><jats:sec><jats:title>Case</jats:title><jats:p> A 48-year-old female patient presented with Broca’s aphasia and mild hemiparesis on the right side. Diagnostic work-up revealed left middle cerebral artery (MCA) occlusion yet without diffusion-weighted lesions. Due to a thrombocytopenia (67.00 g/l) systemic thrombolysis was not indicated and endovascular treatment was initiated 150 min after symptom onset. After successful clot retrieval, recurrent re-occlusions lead to the necessity of stent implantation and anticoagulation, respectively. On day 5 she developed a new severe right-sided hemiparesis. The magnetic resonance imaging (MRI) showed a subtotal restenosis of the left MCA despite the regular anticoagulation regime leading to a new left MCA ischaemic stroke. In the meantime, the unknown aetiology, the patients’ age and the thrombocytopenia let to further diagnostic workup. Elevated blood parameters such as lupus anticoagulant (LA)-1, LA-ratio, positive anti-nuclear antibody (ANA), p-anti-neutrophil cytoplasmic antibodies (ANCA), c-ANCA confirmed the diagnosis of APS. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> This case report showed the feasibility of mechanical clot retrieval and stent implantation in patients with APS. Due to the elevated risk of in-stent thrombosis a prolonged therapy with glycoprotein (GP)IIb/IIIa receptor antagonists in the initial postoperative period and further anticoagulation with coumarin derivate might be needed. </jats:p></jats:sec>

Successful intravenous thrombolysis in a patient with antiphospholipid syndrome, acute ischemic stroke and severe thrombocytopenia

“…Patients for whom intravenous thrombolysis is contraindicated can be considered for salvage intra-arterial therapy or endovascular approaches such as mechanical thrombectomy, but these procedures were not a practical possibility in our case. Indeed, Stadler et al [3] recently reported the case of a 48-year-old woman with APS and an MCA stroke with thrombocytopenia (67 k/ml) treated with mechanical thrombectomy and successful clot retrieval 150 min after symptom onset. Despite our case this should still be considered the firstline treatment, if available.…”

Antiphospholipid Syndrome and the Neurologist: From Pathogenesis to Therapy

“…aPL-induced thrombocytopenia or prolongation of prothrombin time are issues to be considered before starting treatment ( 111 ). Primary endovascular thrombectomy may be considered as an alternative in these patients ( 112 ). Anticoagulation with warfarin and INR 2–3 is the most common strategy for secondary thromboprophylaxis ( 113 ).…”

“…Sirolimus is a macrolide with inhibiting properties on the mammalian target of rapamycin (mTOR), a kinase involved in many signaling pathways related to cellular growth, proliferation, and survival ( 112 ). Previous studies have highlighted the possibility of the involvement of mTOR in the genesis of vascular stenosis in the context of endothelial injury ( 171 , 172 ).…”

A Vascular Thrombus Therapy Method Based on Magnetic‐Induced Vibration

“…Effective treatments of vascular thrombus have always been the most concern for many researchers. Traditional therapies for vascular thrombus include anticoagulant therapy, thrombolytic therapy, thrombectomy, and other methods [Enomoto et al, 2014;Stadler et al, 2015;Bohorquez et al, 2017;Martinez et al, 2017;Atas et al, 2018;Radke and Möckel, 2018]. Anticoagulant therapy is a preferred way in a clinic [Atas et al, 2018].…”

“…Thrombectomy is a mechanical method of removing thrombus, including cerebral artery intervention, coronary intervention, pulmonary artery intervention, and other minimally invasive interventional therapies. It has been a new method for vascular thrombus treatment in recent years [Sitti et al, ; Stadler et al, ; Liu et al, ].…”