An 80-year-old woman presented with impaired consciousness after malignant melanoma resection. Magnetic resonance angiography showed basilar artery occlusion, which was subjected to mechanical thrombectomy for recanalization. A pathological analysis of the retrieved embolus revealed that it was derived from a metastasis of malignant melanoma. Contrast-enhanced chest computed tomography showed multiple pulmonary metastases, one of which was in the right upper lobe and invaded the pulmonary vein. To our knowledge, this is the first case of white embolus-induced cerebral embolism due to pulmonary vein invasion of a metastasis of a pathologically diagnosed malignant melanoma.
Background:
In rare cases, septic embolism is diagnosed on the basis of pathological findings of retrieved thrombi. Infected aneurysms can rapidly form and rupture after septic embolism, leading to a poor prognosis. We report a case of subcortical hemorrhage due to an infected aneurysm forming shortly after septic embolism in the left anterior cerebral artery.
Case Description:
In this case, the diagnosis of septic embolism was made on the basis of pathological findings of a thrombus retrieved from the simultaneously occluded left middle cerebral artery, and endovascular embolization of the infected aneurysm was performed.
Conclusion:
The pathological findings of a retrieved thrombus were useful for making a diagnosis of septic embolism. The possibility of short-term formation and rupture of an infected aneurysm after septic embolism should be noted. Endovascular embolization of occluded vessels due to septic embolism may prevent aneurysm formation and subsequent bleeding.
BACKGROUND
In mechanical thrombectomy for acute large vessel occlusion, a combined technique of using both a stent retriever and an aspiration catheter has been widely used. The authors report a case in which a stent retriever’s pushwire and a microcatheter were caught and disconnected by an accordion-like deformed aspiration catheter.
OBSERVATIONS
A 74-year-old man underwent mechanical thrombectomy for a left M1 occlusion. A stent retriever was deployed from the left M2 to the left distal M1, and an aspiration catheter was advanced to the left distal M1. When the stent retriever and microcatheter were pulled into the aspiration catheter at the distal M1 without releasing the deflection, traction resistance of the stent retriever occurred, and the aspiration catheter contracted and deformed like an accordion distal to the tip of the guiding catheter. The stent retriever’s pushwire and the microcatheter were caught and disconnected.
LESSONS
When a stent retriever is pulled into a flexible aspiration catheter in a case with vascular tortuosity, it may be caught by an accordion-like deformed aspiration catheter and disconnected. It is necessary to release the deflection of the aspiration catheter once traction resistance of the stent retriever and deflection of the aspiration catheter occur.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.