Abstract Introduction Malignancy-associated hypercoagulability combined with mechanical factors like stents increases the risk of thrombosis, which can prove to be fatal. We present a case of pulmonary artery stent thrombosis in a patient with advanced malignancy, emphasizing the need for vigilant post-intervention surveillance in high risk patient. Case A 50-year-old woman with Stage IV Anal squamous cell carcinoma metastatic to the lungs and mediastinum presented to the ED after being found unresponsive at home. Her malignancy was complicated airway obstruction from bronchial compression requiring Y-shaped tracheobronchial stenting, and pulmonary artery stenosis treated with a right pulmonary artery stent graft. On arrival to ED, she had a GCS of 3 and was in VFib arrest. After 3 rounds of CPR and 1 defibrillation, she achieved a ROSC and was subsequently intubated. Post-arrest EKG showed STEMI likely from global ischemia. Blood work was notable for severe metabolic & respiratory acidosis with pH 6.8, rising troponins, leukocytosis and anemia. 2D-Echo demonstrated severely reduced LV function. Her prior bronchoscopies documented progressive obstruction of the right mainstem bronchial stent due to tumor burden and mucus plugging, with multiple stent revisions performed over the year. CTA revealed thrombosis of the previously placed right pulmonary artery stent with a collapsed right lung. Notably, she had been on Eliquis at home, which was held for 3 days during her last bronchoscopy 20 days before presentation. Anticoagulation with a heparin drip was started in the ED. She was continued on lung-protective mechanical ventilation. Vasopressors were titrated to maintain MAP≥65. Supportive care was given with bronchodilators, empiric antibiotics, bronchopulmonary hygiene, fluid and electrolyte monitoring. Vascular surgery was consulted, and the patient was eventually transferred to a higher-level facility for further management. Despite maximal supportive measures her condition deteriorated. The family opted for comfort care, and she passed away. Discussion Pulmonary artery stents are typically reserved for severe vascular compromise. There are no robust large-scale studies reporting pulmonary artery stent thrombosis but given hypercoagulable state in cancer, the risk may be higher than coronary counterparts in oncological patients. In our case, stenting was necessitated by right pulmonary artery stenosis due to tumor burden. This case emphasized the need for closer peri-procedural monitoring and individualized anticoagulation strategies in patients with cancer-associated thrombosis. This abstract is funded by: NONE
Gupta et al. (Fri,) studied this question.