Histological Examination of Trousseau Syndrome-Related Thrombus Retrieved Through Acute Endovascular Thrombectomy: Report of 2 Cases

Matsumoto, Naoki; Fukuda, Hitoshi; Handa, Akihiro; Kawasaki, Toshinari; Kurosaki, Yoshitaka; Chin, Masaki; Yamagata, Sen

doi:10.1016/j.jstrokecerebrovasdis.2016.08.041

Cited by 37 publications

(23 citation statements)

References 12 publications

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“…Although the residual thrombus could not be recovered with a suction catheter, it could be fortunately recovered as the stent struts bit deep into it. Matsumoto et al pathologically examined the thrombi retrieved from two patients with major artery occlusion associated with Trousseau syndrome 2) and reported that thrombi recovered from patients with cerebral infarction due to atherothrombotic occlusion or non-valvular atrial fibrillation were rich in blood cell components and fragile, but that those recovered from two patients with Trousseau syndrome were both white thrombi, 90% or more of which consisted of fibrin. Concerning the properties of thrombi and thrombectomy devices, Yuki et al reported that the necessary number of procedures was higher, and the recanalization rate was lower, in fibrin-dominant thrombi compared with red blood cell-dominant thrombi in animal experiments of thrombectomy using Merci retriever (Concentric Medical, Mountain View, CA, USA).…”

Section: Discussionmentioning

confidence: 99%

“…According to our review, there have been only two reports of three cases who underwent thrombectomy for occlusion of the major intracranial arteries due to Trousseau syndrome. 1,2) Trousseau syndrome is considered to be caused frequently by small thrombi from NBTE, and they are likely to cause peripheral embolism without occluding the major arteries, but reports of similar cases are expected to increase in the future with the prevalence of thrombectomy devices and establishment of evidence of clot retrieval therapy. In our patient, partial recanalization could be achieved by performing a thrombectomy procedure using Trevo provue twice.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, evidence of mechanical thrombectomy for acute cerebral infarction due to major intracranial vessel occlusion has been established, but only three cases of Trousseau syndrome that underwent mechanical thrombectomy have been reported. 1,2) In this report, we present a case that showed temporary improvement by mechanical thrombectomy but had multiple early recurrences and died.…”

Section: Introductionmentioning

confidence: 89%

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A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

Shinohara

Tsumura

Hasegawa

et al. 2017

JNET

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Objective and Case Presentation:The patient was an 86-year-old woman with histories of surgery for stomach, colon, and pancreatic cancers. In addition to left hemiparesis as a sequela of two past episodes of cerebral infarction, she newly developed right hemiplegia and acute cerebral infarction due to left middle cerebral artery (MCA) occlusion.Since the condition was not an indication for intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA), mechanical thrombectomy was immediately performed, and almost complete recanalization could be achieved about 5 hours after the onset. The retrieved thrombus was a white and elastic hard fibrin thrombus that contained no blood cells. Although temporary symptomatic relief was obtained, bilateral MCA occlusion occurred in succession, and the patient died on the 35th day of illness. Conclusion:Accumulation of cases and pathological evaluation of retrieved thrombi are necessary for the elucidation of the optimal mechanical thrombectomy or antithrombotic therapy for acute cerebral infarction due to Trousseau syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

See 1 more Smart Citation

A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

Shinohara

Tsumura

Hasegawa

et al. 2017

JNET

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“…Concerning drug therapy for TS-related embolism, there is no evidence regarding selective Xa or thrombin inhibitors. 5) Although heparin is effective, 3) recurrent thrombosis related to the discontinuation of heparin was reported; 3) the administration method and period must be reviewed. In the present case, embolism also recurred after the discontinuation of heparin; the necessity of continuous drip infusion over a long period should be reviewed.…”

Section: Disclosure Statementmentioning

confidence: 99%

A Patient with Cerebral Embolism Related to Trousseau’s Syndrome

Nishimuta

Nagayama²,

Hiwatari

et al. 2017

JNET

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We report a patient with acute-phase cerebral embolism related to Trousseau's syndrome (TS) in whom thrombectomy was performed, and white thrombi were captured. Case Presentation: The patient was a 65-year-old female. Sudden-onset dizziness and progressive consciousness disorder were noted. Diagnostic imaging led to a diagnosis of occlusion of the basilar artery (BA). In the acute phase, thrombectomy was performed, and white thrombi were captured, differing from standard-type embolism. After surgery, the symptoms rapidly reduced, but systemic investigation suggested advanced gastric cancer as an etiologic factor for embolism. Subsequently, embolism recurred, and the patient died of hemorrhagic cerebral infarction 31 days after onset. Conclusion: If a white thrombus is captured during thrombectomy, TS should be differentiated as an etiologic factor.

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“…Therefore, the clinical results of EVT in patients with concomitant malignancy have not been fully elucidated. Short-term results of EVT in concomitant cancer patients seem favorable (12)(13)(14). However, long-term prognosis has not been reported.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

et al. 2020

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Endovascular thrombectomy (EVT) is the preferred treatment strategy for patients with acute ischemic stroke (AIS). However, clinical outcome and prognosis in patients who undergo EVT in response to AIS with concomitant malignancy have not been fully elucidated. Data of patients with malignancy who underwent EVT at participating institutions between January 2015 and April 2019 were retrospectively analyzed. Patient characteristics, treatment methods, posttreatment strategy, and long-term prognosis were evaluated in 12 patients with prediagnoses of malignancy. Good revascularization (TICI 2b or higher) was achieved in 10 of 12 patients. Among the eight patients who survived more than 2 weeks from onset, four patients showed good clinical outcome [modified Rankin Scale (mRS) <2] at 60 days posttreatment and were able to continue treatment for malignancy. However, seven of eight patients died within a year of EVT (median survival, 83 days) due to progression of malignancy. One-year survival was achieved in only one patient whose etiology of stroke was determined as infectious endocarditis and not Trousseau syndrome. Even after successful revascularization and good short-term clinical outcome, the long-term prognosis after thrombectomy in patients with malignancy was poor. Thrombectomy for concomitant malignancy requires judicious decision, and further studies are necessary to fully elucidate its efficacy.

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Histological Examination of Trousseau Syndrome-Related Thrombus Retrieved Through Acute Endovascular Thrombectomy: Report of 2 Cases

Cited by 37 publications

References 12 publications

A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

A Patient with Cerebral Embolism Related to Trousseau’s Syndrome

Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

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