Mechanical thrombectomy for middle cerebral artery occlusion associated with ovarian hyperstimulation syndrome: case report and review of the literature

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a rare but serious complication of assisted reproductive technology application. The incidence of stroke symptoms associated with OHSS is lower than that of abdominal symptoms, which may occur in severe OHSS situation. If tissue plasminogen activator (tPA) is not applicable, mechanical thrombectomy (MT) is recommended for acute cerebral artery occlusion within 6 hours of symptom onset according to the current guidelines. However, the current experience and evidence is insufficient, whether acute cerebral artery occlusion associated with OHSS can be treated with MT. A 21-year-old woman underwent an ovulation induction with gonadotropin-releasing hormone agonist. Two days later, she presented with abdominal distension and diarrhea. Ascites and enlarged ovaries were confirmed by ultrasound. She was highly suspected of OHSS in by the Department of Obstetrics and Gynecology. Three days later, she presented with right-side hemiplegia, superficial coma, and aphasia, and right Babinsky sign was positive. The patient was diagnosed with left middle cerebral artery (LMCA) occlusion by computed tomography angiography (CTA). We performed emergent MT and achieved revascularization within 6 hours of cerebral ischemic symptom onset. After operation, the patient underwent various examinations, and ultrasound revealed deep vein thrombosis and right-to-left shunt due to cardiac atrial septal defect in this case. We thus reasoned that LMCA occlusion could be highly associated with OHSS. At 3-month follow-up, the patient recovered to a normal situation and was left with no neurological dysfunction. We here report MT treatment for a rare cerebral artery occlusion case associated with OHSS in right-to-left shunt patient. It is necessary to pay attention to ischemic symptoms in a severe OHSS situation in aggressive infertility treatment, especially in right-to-left shunt patients. More future studies are recommended for determining the effectiveness of the MT treatment in cerebral artery occlusion associated with OHSS.

Keywords: Artery occlusion; mechanical thrombectomy (MT); ovarian hyperstimulation syndrome (OHSS).