Successful Treatment of Repeated Bilateral Middle Cerebral Artery Occlusion by Performing Mechanical Thrombectomy in a Patient with Trousseau Syndrome

• Published in: Nō shinkei geka Vol. 44; no. 6; p. 501
• Main Authors: Inoue, Satoshi, Fujita, Atsushi, Mizowaki, Takashi, Uchihashi, Yoshito, Kuroda, Ryuichi, Urui, Seishirou, Kurihara, Eiji, Kohmura, Eiji
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.06.2016
• Subjects: Aged; Anticoagulants - therapeutic use; Cerebrovascular Circulation; Diffusion Magnetic Resonance Imaging; Humans; Infarction, Middle Cerebral Artery - drug therapy; Infarction, Middle Cerebral Artery - surgery; Magnetic Resonance Angiography; Male; Neurosurgical Procedures; Stents; Thrombectomy
• ISSN: 0301-2603
• DOI: 10.11477/mf.1436203318

We report a patient with Trousseau syndrome who presented with repeated acute middle cerebral artery (MCA) occlusion, which was successfully treated by performing mechanical thrombectomy. A 66-year-old man with a lung lesion and abdominal lymph node swelling experienced a sudden onset of left hemiparesis. Magnetic resonance angiography (MRA) revealed a right MCA occlusion. Perfusion-weighted imaging revealed reduced cerebral blood flow in the right MCA territory. Complete recanalization of the occluded vessel was achieved by performing mechanical thrombectomy, and his symptoms remarkably disappeared. Twenty days after the procedure, he experienced right hemiparesis and total aphasia. MRA revealed a left MCA occlusion, which was located on the contralateral side of the first occlusion. The second mechanical thrombectomy was successfully performed, and complete recanalization was successfully achieved. Right hemiparesis improved after the procedure. Histological examination of the retrieved clots revealed coagulated fibrin and platelets. Cytodiagnosis of pleural effusion revealed adenocarcinoma, and he was diagnosed with lung adenocarcinoma and cancerous pleurisy. Trousseau syndrome was the presumed primary cause of the patient's tendency for thrombogenesis. To the best of our knowledge, there were no reports regarding the repeated use of mechanical thrombectomy for patients with bilateral MCA occlusion caused by Trousseau syndrome. Neuroendovascular therapy can offer good neurological outcomes even in patients with malignant lesions.