Intravascular Mechanical Thrombectomy for a Patient with Systemic Lupus Erythematosus and Acute Cerebral Infarction with Antiphospholipid Syndrome
International Journal of Psychological and Brain Sciences
Volume 5, Issue 1, February 2020, Pages: 21-27
Received: Jan. 19, 2020;
Accepted: Feb. 13, 2020;
Published: Feb. 20, 2020
Views 342 Downloads 123
Jiaxia Li, Department of Neurology, Hefei Second People’s Hospital, Hefei, China
Shugang Cao, Department of Neurology, Hefei Second People’s Hospital, Hefei, China
Wei Hu, Department of Neurology, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
Yuyou Zhu, Department of Neurology, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
Mingwu Xia, Department of Neurology, Hefei Second People’s Hospital, Hefei, China
Systemic lupus erythematosus (SLE) is a diffuse connective tissue disease that is characterized by autoimmune-mediated inflammation. Antiphospholipid syndrome (APS) is a non-inflammatory autoimmune disease. A 55-year-old female patient was admitted to the hospital due to ‘sudden speech insufficiency and aggravation of 5 h’. The patient developed sudden dizziness, facial numbness, and slurred speech and was transported to the emergency department in a local hospital, and was diagnosed ‘cerebral infarction’ after a CT examination. According to the medical records, the patient developed SLE at the age of 25. CT showed low density lesions of the left pons and occipital lobe; emergent MRI showed bilateral infarction in the cerebellum and brainstem, and magnetic resonance angiography (MRA) showed upper basilar artery occlusion. Ischemic stroke was diagnosed and NIHSS scored 30. The occluded artery was successfully recanalized with endovascular mechanical thrombectomy. Modified thrombolysis in cerebral infarction (mTICI) blood flow perfusion grade was grade 3. The case is the first one in the literature that acute ischemic stroke related to SLE vasculitis and antiphospholipid syndrome was treated successfully with endovascular mechanical thrombectomy.
Intravascular Mechanical Thrombectomy for a Patient with Systemic Lupus Erythematosus and Acute Cerebral Infarction with Antiphospholipid Syndrome, International Journal of Psychological and Brain Sciences.
Vol. 5, No. 1,
2020, pp. 21-27.
Chinese Medical Association Rheumatology Branch. Guidelines for the diagnosis and treatment of systemic lupus erythematosus [J]. Chinese Journal of Rheumatology, 2010, 14 (5): 342-346.
Chen, X., & Xu, G. (2018). Intravenous thrombolysis in SLE-related stroke: a case report and literature review. Neurological Sciences, 39 (1), 155-159.
Wiseman, S. J., Bastin, M. E., Jardine, C. L., Barclay, G., Hamilton, I. F., Sandeman, E., & Ralston, S. H. (2016). Cerebral small vessel disease burden is increased in systemic lupus erythematosus. Stroke, 47 (11), 2722-2728.
Holmqvist, M., Simard, J. F., Asplund, K., & Arkema, E. V. (2015). Stroke in systemic lupus erythematosus: a meta-analysis of population-based cohort studies. RMD open, 1 (1), e000168.
Lim, W. (2009). Antiphospholipid antibody syndrome. Hematology Am Soc Hematol Educ Program, 233-239.
Loharia, J. J., Alam, J. M., Abdelhadi, H. A., & Marei, T. F. (2015). Thrombolytic therapy at systemic lupus onset with secondary antiphospholipid syndrome: A rare stroke experience. Neurosciences, 20 (1), 55.
Camara-Lemarroy, C. R., Infante-Valenzuela, A., Andrade-Vazquez, C. J., Enriquez-Noyola, R. V., Garcia-Valadez, E. A., & Gongora-Rivera, F. (2016). Successful intravenous thrombolysis in a patient with antiphospholipid syndrome, acute ischemic stroke and severe thrombocytopenia. Blood Coagulation & Fibrinolysis, 27 (3), 354-356.
Majdak, M. R., & Vuletić, V. (2016). Thrombolysis for acute stroke in patient with systemic lupus erythematosus: A case report. Journal of the neurological sciences, 361, 7-8.
Khatri, R., Vellipuram, A. R., Maud, A., Cruz-Flores, S., & Rodriguez, G. J. (2018). Current endovascular approach to the management of acute ischemic stroke. Current cardiology reports, 20 (6), 46.
Mazya, M. V., Lees, K. R., Collas, D., Rand, V. M., Mikulik, R., Toni, D. & Ahmed, N. (2015). IV thrombolysis in very severe and severe ischemic stroke: results from the SITS-ISTR Registry. Neurology, 85 (24), 2098-2106.
Yifeng W., Yun X., Xueling Z., Junshan Z., Hongchao S., & Jingwei L. (2018). Comparison of safety and effectiveness of direct thrombectomy and bridging therapy within 4.5 hours of stroke in acute large vessel occlusion. International Journal of Cerebrovascular Disease, 26 (4): 257 -261.
Fernández-Nebro, A., Rúa-Figueroa, Í., Lopez-Longo, F. J., Galindo-Izquierdo, M., Calvo-Alén, J., Olivé-Marqués, A.,... & Ibáñez-Rúan, J. (2015). Cardiovascular events in systemic lupus erythematosus: a nationwide study in Spain from the RELESSER registry. Medicine, 94 (29).
Wick, G., Schett, G., Amberger, A., Kleindienst, R., & Xu, Q. (1995). Is atherosclerosis an immunologically mediated disease?. Immunology today, 16 (1), 27-33.
Kabakov, A. E., Tertov, V. V., Saenko, V. A., Poverenny, A. M., & Orekhov, A. N. (1992). The atherogenic effect of lupus sera: systemic lupus erythematosus-derived immune complexes stimulate the accumulation of cholesterol in cultured smooth muscle cells from human aorta. Clinical immunology and immunopathology, 63 (3), 214-220.
Cerrato, P., Berardino, M., Bottacchi, E., Corso, G., Lentini, A., Bosco, G. & Bergui, M. (2008). Vertebral artery dissection complicated by basilar artery occlusion successfully treated with intra-arterial thrombolysis: three case reports. Neurological Sciences, 29 (1), 51-55.
Mattle, H. P., Arnold, M., Lindsberg, P. J., Schonewille, W. J., & Schroth, G. (2011). Basilar artery occlusion. The Lancet Neurology, 10 (11), 1002-1014.
Bhatti, A., & Sivakumaran, P. (2017). Intra-arterial Treatment for Basilar Artery Occlusion. JAMA neurology, 74 (1), 130-130.
Park, H., jun Hwang, G., Jin, S. C., Jung, C. K., Bang, J. S., Han, M. K.,... & Kwon, O. K. (2011). A retrieval thrombectomy technique with the Solitaire stent in a large cerebral artery occlusion. Acta neurochirurgica, 153 (8), 1625-1631.
Gory, B., Sivan-Hoffmann, R., Riva, R., Labeyrie, P. E., Huguet, N., Nighoghossian, N., & Turjman, F. (2015). Repeated Solitaire mechanical thrombectomy in an acute anterior stroke patient. Revue neurologique, 171 (8-9), 682.
McCabe, J. J., Phillips, T. J., Phatouros, C., Singh, T., Blacker, D., Hankey, G. J., & McAuliffe, W. (2013). Mechanical thrombectomy with the Solitaire AB device in large intracerebral artery occlusions. Journal of medical imaging and radiation oncology, 57 (2), 149-155.
Chunxia Z., Wanchao S., Futang X., & Chen L. (2018). Solitaire AB stent mechanical thrombectomy for acute ischemic stroke: comparison of cardiogenic embolism and aortic atherosclerotic stroke. International Journal of Cerebrovascular Disease, 26 (6): 401-406.