A Case of an Early Pregnant Woman with Congenital Protein S Deficiency Who Underwent Mechanical Thrombectomy

Abstract

Objective: Large vessel occlusion (LVO) stroke during pregnancy is rare but a life-threatening issue for the mother and fetus. We report a rare case of a pregnant woman with congenital protein S deficiency who underwent mechanical thrombectomy.

Case presentation: A 35-year-old woman presented with right hemiplegia and aphasia. The National Institutes of Health Stroke Scale was 23 and MRI revealed acute infarction on the left hemisphere. MRA showed disruption of the left middle cerebral artery. Mechanical thrombectomy was performed following intravenous thrombolysis, and then complete recanalization was achieved. The reduction in protein S activity due to pregnancy was suspected to have affected LVO. Subsequently, the patient was diagnosed with congenital protein S deficiency and recovered to modified Rankin scale 2 at 3 months after the onset.

Conclusion: Aggravation of congenital protein S deficiency due to pregnancy led to the onset of LVO. The patient showed a good outcome after mechanical thrombectomy.

Keywords: pregnancy; protein S; stroke; thrombectomy; tissue plasminogen activator.

Fig. 1. (A and B) DWIs show acute stroke on the left hemisphere (DWI-ASPECTS is 3). (C) MRA shows disruption of the left middle cerebral artery at the M1 segment (white arrowhead). (D and E) FLAIR 2 days after the onset show the hyperintense area in part of the area of the left middle cerebral artery. ASPECTS: Alberta stroke program early CT score; DWI: diffusion-weighted image

Fig. 2. (A) Left carotid angiogram shows occlusion of the left middle cerebral artery (black arrowhead). (B) Left carotid angiogram shows complete recanalization after the mechanical thrombectomy.

Fig. 3. The transition of free protein S antigen, total protein S antigen, and protein S activity during the course of treatment. APTT: activated partial thromboplastin time; PT–INR: prothrombin time international normalized ratio