Intravascular Mechanical Thrombectomy for a Patient with Systemic Lupus Erythematosus and Acute Cerebral Infarction with Antiphospholipid Syndrome

Jiaxia Li,Wei Hu,Yuyou Zhu,Mingwu Xia,Shugang Cao

doi:10.11648/j.ijpbs.20200501.13

Abstract

Systemic lupus erythematosus (SLE) is a diffuse connective tissue disease that is characterized by autoimmune-mediated inflammation. Antiphospholipid syndrome (APS) is a non-inflammatory autoimmune disease. A 55-year-old female patient was admitted to the hospital due to ‘sudden speech insufficiency and aggravation of 5 h’. The patient developed sudden dizziness, facial numbness, and slurred speech and was transported to the emergency department in a local hospital, and was diagnosed ‘cerebral infarction’ after a CT examination. According to the medical records, the patient developed SLE at the age of 25. CT showed low density lesions of the left pons and occipital lobe; emergent MRI showed bilateral infarction in the cerebellum and brainstem, and magnetic resonance angiography (MRA) showed upper basilar artery occlusion. Ischemic stroke was diagnosed and NIHSS scored 30. The occluded artery was successfully recanalized with endovascular mechanical thrombectomy. Modified thrombolysis in cerebral infarction (mTICI) blood flow perfusion grade was grade 3. The case is the first one in the literature that acute ischemic stroke related to SLE vasculitis and antiphospholipid syndrome was treated successfully with endovascular mechanical thrombectomy.

Highlights

Systemic lupus erythematosus (SLE) is a diffuse connective tissue disease characterized by autoimmune-mediated inflammation
The main disadvantages of intravenous thrombolysis are that the time window is narrow, the contraindications are relatively large with high risk of Jiaxia Li et al.: Intravascular Mechanical Thrombectomy for a Patient with Systemic Lupus Erythematosus and
Indications for intravascular mechanical thrombectomy in patients with basilar artery occlusion are: (1) clinical diagnosis of ischemic stroke and develops measurable neurological deficits such as language, motor function, cognitive impairment, gaze disorder, visual field defects and/or visual neglect within 24 hours of onset; (2) cerebrovascular evaluation indicates the presence of basilar artery occlusion; (3) based on clinical and imaging evaluations, patients are likely to benefit from endovascular treatment; (4) patients have signed the informed consent form

Summary

Introduction

Systemic lupus erythematosus (SLE) is a diffuse connective tissue disease characterized by autoimmune-mediated inflammation. It is mainly characterized by the emergence of antinuclear antibodies (ANA) in serum. Antiphospholipid syndrome (APS) is a non-inflammatory autoimmune disease It is clinically diagnosed with arterial and venous thrombosis and/or pathological pregnancy (early miscarriage and stillbirth) and/or thrombocytopenia as the main manifestation, and the antiphospholipid antibody (aPL) in patient's serum shows positive [1]. Treatment of acute ischemic stroke in patients with SLE and APS is limited. Acute Cerebral Infarction with Antiphospholipid Syndrome bleeding, and the recanalization rate of acute ischemic stroke caused by large vessel occlusion is not high [9]. It is hoped that it would provide reference for the treatment of such patients

Clinical Information

Evaluation of Surgical Standards

Surgical Process and Prognosis

Discussion

Conclusion