Mechanical Thrombectomy for Trousseau Syndrome in a Terminally Ill Cancer Patient

Abstract

Trousseau syndrome was first described by Armand Trousseau in 1865 and is characterized by hypercoagulation resulting from malignant tumors. This complication can markedly impact quality of life (QOL). This is the first report of a terminally ill patient who developed large-vessel occlusion stroke from Trousseau syndrome and underwent mechanical thrombectomy. A 75-year-old woman presented with Stage IV ovarian cancer. Goals of care were transitioned to palliative care. The patient was hospitalized with vertebral compression fracture and suddenly developed right hemiparesis and total aphasia during admission. Magnetic resonance imaging and angiography showed occlusion of Segment 1 of the left middle cerebral artery. We administered tissue-plasminogen activator, but symptoms remained unimproved. We performed mechanical thrombectomy based on medical indications and with the consent of her family. Thrombectomy improved symptoms dramatically. She was able to walk and talk with her family at discharge. She eventually died of respiratory failure on postoperative Day 98, but QOL remained high for those 98 days. Mechanical thrombectomy has the potential to markedly improve QOL in terminally ill patients with large-vessel occlusion associated with Trousseau syndrome.

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

“…This is because the onset of stroke is considered to affect the overall mortality in patients with malignancy due to the contribution of various factors including termination of malignancy treatment and worsening of general condition (immune system, nutrient state, and frailty). However, our results showed that even with the poor long-term prognosis, EVT could at least recover performance status and enable improved quality of life in some patients ( 14 ).…”

“…Prestroke mRS score was 0 for nine patients, 2 for one patient, and 3 for two patients. NIHSS score at admission was 17.2 [interquartile range (IQR), [14][15][16][17][18][19][20][21] and ASPECTS ranged from 8 to 10. The location of atrial occlusions was determined at the internal cerebral artery (ICA) (n = 2), proximal portion of the middle cerebral artery (MCA) (M1; n = 8), and middle portion of the MCA (M2; n = 2).…”

“…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 – 14 ). However, long-term prognosis has not been reported.…”

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

“…This is the first report of dual endovascular intervention in a CCI patient with Trousseau syndrome. Endovascular therapy for cerebral infarction in Trousseau syndrome is rarely reported (2–4). All of these previous cases exhibited terminal stage of cancer, elevated D-dimer, and thrombus with white coloration consisting of fibrin and platelets.…”

“…Trousseau syndrome is a condition characterized as hypercoagulation disorder related to malignancy (1). It is considered a common cause of ischemic stroke in terminally ill patients, and several affected patients have been reported to undergo mechanical thrombectomy (2–4). Here, we report a rare case of synchronous cardiocerebral infarction (CCI) caused by Trousseau syndrome in a patient who underwent endovascular therapy to treat both infarctions.…”