2023 Volume 45 Issue 6 Pages 479-485
A 78-year-old woman was diagnosed with cerebral infarction due to left hemiplegia by her family physician and was transferred to our hospital. On arrival, she had the NIHSS score of 15, right M1 occlusion on head MRA taken by her family physician, and a DWI-Alberta stroke program early CT score (DWI-ASPECTS) of 8. A white thrombus was retrieved by thrombectomy, and recanalization of thrombolysis in cerebral infarction (TICI) grade 3 was obtained, but the left hemiplegia did not resolve. On day 2, there was progression of impaired consciousness, the NIHSS score was 19, right M1 occlusion was observed again on head MRA, and the DWI-ASPECTS was 5. A white thrombus was retrieved again by the second thrombectomy, leading to TICI grade 2b recanalization. Postoperative contrast-enhanced CT of the trunk showed advanced pancreatic cancer. Based on elevated D-dimer levels and characteristics of the thrombi, we determined that the mechanism of the first M1 occlusions was cancer-associated embolism. The patient died of the primary disease on day 39. Cancer-associated occlusion of the major cerebral artery requires careful follow-up because of the possibility of reocclusion of recanalized sites with vascular endothelial damage due to hypercoagulable conditions in a short time period after mechanical thrombectomy.
