Key result
Multivessel thrombectomy and lifelong anticoagulation resolve simultaneous arterial and venous thrombi in malignancy.
Why the study?
Thrombosis is a dangerous complication of cancer, but simultaneous separate thrombus formation across both the venous and arterial circulation is rare.
Can multiple consecutive invasive thrombectomy procedures and long-term anticoagulation successfully treat simultaneous multiorgan thrombosis in a patient with active malignancy?
Case Report (n=1)
No
Can multiple consecutive invasive thrombectomy procedures and long-term anticoagulation successfully treat simultaneous multiorgan thrombosis in a patient with active malignancy?
This case highlights that consecutive invasive mechanical thrombectomies in multiple vascular beds can be performed safely to manage simultaneous multi-organ thrombosis in patients with malignancy-associated hypercoagulability.
Supports feasibility of multi-bed thrombectomy in malignancy-associated multiorgan thrombosis; hypothesis-generating, requires prospective validation.
BACKGROUND: Thrombosis is a dangerous complication of cancer. At least 20% of cancer patients are diagnosed with a venous thrombotic event and 1% with an intra-arterial thrombotic event. Here, we present a patient that developed separate thrombi that occurred simultaneously in both the venous and arterial circulation. CASE SUMMARY: An 80-year-old woman with a history of recently diagnosed squamous cell lung cancer presented to our institution with an out of hospital cardiac arrest. On arrival, she was found to have an inferior ST-elevation myocardial infarction on electrocardiogram and on examination was found to have right-sided neurological deficits. Computed tomography head and aortogram showed an acute ischaemic stroke and bilateral segmental pulmonary emboli. Coronary angiogram showed thrombotic occlusion distal to the right coronary artery, and the patient underwent aspiration thrombectomy with thrombolysis in myocardial infarction 3 flow established at the end of the procedure. The patient was then transferred to interventional radiology where she had successful clot retrieval of the cerebral thrombus. The patient progressed well and had full neurological recovery 72 h post-presentation. Subsequent transoesophageal echocardiography showed no evidence of a patent foramen ovale or other intracardiac shunt. The patient was prescribed long-term anticoagulant with Clexane. DISCUSSION: There was suspicion for a deep vein thrombosis with subsequent embolization to the lungs and paradoxical embolization through an intracardiac shunt. However, no such defect was detected and it appears that the patient did develop thrombi in the arterial and venous system separately. This case highlights the prothrombotic state of malignancy, with the patient suffering from multiple separate life-threatening thrombi.
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Wang et al. (2019) conducted a case report in Stage III squamous cell lung cancer with simultaneous multiorgan thrombosis (pulmonary emboli, ischemic stroke, STEMI) (n=1). Coronary aspiration thrombectomy, cerebral clot retrieval, and anticoagulation was evaluated on Neurological recovery and prevention of recurrent thrombosis. Multiple consecutive invasive thrombectomy procedures followed by lifelong anticoagulation successfully treated simultaneous arterial and venous thrombi in a patient with solid organ malignancy.
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