Endovascular Therapy for Concurrent Cardio-Cerebral Infarction in a Patient With Trousseau Syndrome

Abstract

Only a few patients have been reported to undergo endovascular therapy for Trousseau syndrome. This is the first report of a patient with Trousseau syndrome who developed synchronous cardiocerebral infarction and underwent endovascular therapy for both. A 55-year-old woman with Trousseau syndrome arising from stage IV ovarian cancer presented with consciousness disturbance, aphasia, and right hemiparesis. Magnetic resonance imaging showed acute cerebral infarction limited to the left basal ganglia and occlusion of the left middle cerebral artery (MCA). Electrocardiography showed ST elevation in leads II, III, and aVF with reciprocal change. Mild elevation of myocardial enzymes was observed in laboratory data. She was diagnosed with synchronous cardiocerebral infarction. Both infarctions were considered as appropriately indicated for endovascular therapy. Since her vital signs were stable, a decision was made to treat the cerebral infarction first. Thrombectomy with a stent retriever was performed, which achieved complete recanalization of the left MCA. Percutaneous coronary intervention successfully recanalized the occluded right coronary artery. She suffered no recurrence of stroke or acute coronary syndrome upon heparin administration. Cardiocerebral infarction caused by Trousseau syndrome is rare and demands optimal planning of endovascular therapy.

Multiple Thrombectomies for Cerebral and Coronary Artery Occlusion in Trousseau Syndrome

“…13,14) In these studies, risk factors of re-occlusion included the number of device passes, missed residual thrombus or stenosis on the past angiography after thrombectomy, intracranial ICA or M2 occlusion, stroke of undetermined cause, and statin pretreatment. 13,14) According to our research, there are 14 reported incidences of TS treated by MT with available literature [2][3][4]13,[15][16][17][18][19][20][21][22] (Table 1). Of half of the cases that experienced re-occlusion of the cerebral large vessels, five cases involved the same vessels.…”

“…Sakuta et al reported cerebral LVO with acute myocardial infarction (AMI) in TS. 15) After successful endovascular therapy for both arteries, Fig. 4 Coronary angiography showing occlusion of the left anterior descending branch (A).…”

Trousseau syndrome with intrahepatic cholangiocarcinoma that could be removed radically after endovascular treatment: Report of a case

“…The second important point of this case is endovascular treatment. In general, endovascular treatment is rare in ischemic brain infarctions associated with Trousseau syndrome (Sakuta, Mukai, Fujii, Makita, & Yaguchi, 2019). The reasons are activity of daily living(ADL), location of stroke, time from onset, and so on.…”

Triple Thrombectomy for Trousseau Syndrome: Case Report and Review of the Literature of Stroke Intervention in Cancer-associated Thrombus

“…3) There are now multiple reports of mechanical thrombectomy for Trousseau's syndrome; however, recurrent thrombectomy for stroke is uncommon. [3][4][5][7][8][9][10] In two large series, recurrent thrombosis was reported at about 2%, although not all of these received repeat intervention. 6,11) These series differ on their impression of the impact of recurrent thrombosis.…”

“…TICI 2b recanalization was achieved. 7) Following the third thrombectomy, the patient had residual expressive aphasia but retained the ability to answer "yes/no questions" and to ambulate. He was discharged to home on POD 10, on aspirin and clopidogrel to prevent stent thrombosis, and full-dose enoxaparin for systemic anticoagulation.…”