Deep venous thrombosis post mechanical thrombectomy in acute ischaemic stroke

Abstract

A woman in her 20s presented with neck pain, slurred speech and left-sided weakness. She successfully underwent mechanical thrombectomy (MT) for total occlusion of the basilar artery and made full neurological recovery. Initial ultrasound Doppler of legs (USDL) did not show any deep vein thrombosis (DVT). However, 2 days later, a repeat USDL revealed an extensive proximal DVT in the right common femoral vein. CT scan confirmed a haematoma arising from the femoral access site causing compression of the adjacent common femoral vein. This may have initiated DVT formation or exacerbated extension of a previously undetected DVT. Echocardiogram revealed a patent foramen ovale. As the patient was asymptomatic, delayed or missed diagnosis of DVT would have put her at risk of life-threatening pulmonary embolism or further strokes. Clinicians should maintain a high index of suspicion of DVT as a direct procedural complication from MT so treatment can be initiated promptly.

Keywords: Interventional radiology; Stroke; Venous thromboembolism.

Figure 1

Occlusion of the basilar artery (yellow arrow) on CT angiography of the carotid, vertebral and intracranial arteries.

Figure 2

MRI showing small infarct in the left cerebellum (yellow arrow).

Figure 3

Ultrasound Doppler of the right leg. (A) Carried out at the CSC showing patent common femoral vein with good flow. (B) Carried out at the local hospital 2 days later, which now shows thrombosis (yellow arrows) within the common femoral vein. CSC, comprehensive stroke centre.

Figure 4

CT showing haematoma arising from the common femoral artery (yellow arrow) causing compression of the common femoral vein.