Efficacy of mechanical thrombectomy for acute ischemic stroke in primary immune thrombocytopenia patient: Case report and literature review

Abstract

Objective: Primary immune thrombocytopenia (ITP) paradoxically carries a high risk of developing thrombosis. However, the efficacy of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in ITP patients remains unclear due to its rarity. Case presentation: A 47-year-old female treated for chronic ITP for 2 years was admitted to the hematology department with severe thrombocytopenia. The patient was started on glucocorticoid therapy, and her platelet count rose soon. On sixth day of hospitalization, she suddenly presented with loss of consciousness, conjugate eye deviation to the left, and left hemiplegia. Magnetic resonance imaging and angiography showed an acute ischemic lesion with the left M1 occlusion. Emergent MT was performed and resulted in successful recanalization. Postoperatively, she recovered consciousness and was able to follow instructions. However, on the third day after MT, the patient suffered hemorrhagic infarction and brain herniation, and decompression craniectomy was performed. Her consciousness slowly recovered, and cranioplasty was performed after brain swelling improved. The patient was transferred to a rehabilitation hospital with modified Rankin Scale (mRS) 4 on 84th day of hospitalization, and eventually improved to mRS 3 with motor aphasia and right hemiparesis. Conclusion: MT may be effective for AIS in ITP patients with appropriate case selection.

Keywords

• Acute ischemic stroke
• Cerebral infarction
• Glucocorticoid
• Mechanical thrombectomy
• Primary immune thrombocytopenia
• Tissue-type plasminogen activator