Cerebral fat embolism treated with mechanical embolectomy: Case report and systematic review of the literature

Cerebral fat embolism (CFE) is a rare complication of orthopaedic, cardiac and plastic surgery and major trauma. Mechanical embolectomy has been used as a treatment option for this condition. Here, we described a case report of an elderly woman who developed CFE after a total hip replacement which was treated with mechanical embolectomy with aspiration alone. The patient developed left-sided hemiparesis and abnormal posturing after surgery and a CT angiogram 45 minutes later showed a right M1 embolus with fat attenuation. Mechanical embolectomy with aspiration was conducted to produce a TICI score of 3. No patent foramen ovale (PFO) was found to explain the paradoxical embolism. Subsequently, a systematic literature review on the use of mechanical embolectomy for CFE was conducted, with the databases Medline, Web of Science, Embase, Cinahl and Scopus being searched. The review found 20 cases, 13 of which were treated with aspiration and a stent retriever, and 5 of which were treated with aspiration only. A reduced mortality was observed in the aspiration only cohort compared to the aspiration plus stent retriever cohort, despite both groups having similar age and gender. Among patients treated with stenting, 3 out of 13 (23%) died, compared to 0 out of 5 (0%) patients treated with aspiration alone. Although this difference was not statistically significant, it may reflect a trend worth further exploration, potentially limited by the small sample size. Further registry-based studies and preclinical models are required to elucidate the effectiveness and superior technique of mechanical embolectomy for CFE.