Protruding Aortic Arch Thrombus in Cancer-Associated Stroke: Caution Regarding Endovascular Access.

BACKGROUND

In cancer-associated stroke, thrombi can be present beyond the cerebral vasculature. We report a case in which a protruding thrombus in the aortic arch was identified during the thrombectomy time window.

CASE SUMMARY: A 65-year-old woman with stage IIIC2 endometrial cancer presented with aphasia and right hemiparesis. Magnetic resonance imaging showed acute cerebral infarction in the left temporal lobe with M2 occlusion. Contrast-enhanced imaging revealed multiple thrombi, including a protruding thrombus in the aortic arch as well as others in the celiac artery, pulmonary artery, and femoral veins. Although the patient was eligible for endovascular therapy, the procedure was deferred owing to high risk of further embolization.

DISCUSSION: Endovascular therapy is a potential option in cancer-associated stroke but requires caution when aortic arch thrombi are present owing to increased embolic risk.

TAKE-HOME MESSAGE: Comprehensive vascular imaging is essential in cancer-associated stroke to guide treatment and avoid procedural complications.