Anticoagulant treatment for pulmonary embolism in patient with cerebral hemorrhage secondary to mechanical thrombectomy: A case report.

BACKGROUND: Cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy is characterized by high morbidity, disability and mortality. If the patient also has severe pulmonary embolism (PE) at the same time, the treatment becomes more complex. This report describes the treatment strategy for a patient with PE and cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy. CASE SUMMARY: A 70-year-old woman presented to our emergency department with right-sided hemiplegia and mixed aphasia of 2.5 h duration. She was diagnosed with left cerebral embolism, left internal carotid artery occlusion, PE and left calf intramuscular vein thrombosis. Following mechanical thrombectomy, brain magnetic resonance imaging showed cerebral infarction with basal ganglia hemorrhage. We observed changes in cerebral hemorrhage on serial monitoring of brain computed tomography and adjusted the dose of anticoagulant drugs. After 3 wk of treatment, the patient's neurological and respiratory symptoms significantly improved, and a favorable prognosis was obtained. CONCLUSION: Anticoagulation could be a potential option for PE accompanied by hemorrhagic transformation of an ischemic infarct.

Angioplasty and stenting for severe symptomatic atherosclerotic stenosis of intracranial vertebrobasilar artery.

This retrospective study is to investigate the safety and efficacy of the stent implanting for treating severe symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (ICVBA). 213 patients who had undergone intervention for severe symptomatic ICVBA stenosis between September 2012 to May 2018 were enrolled into this study. Among the 213 enrolled patients, 210 patients (98.6%) obtained successfully revascularization and 206 patients (96.7%) had good revascularization after stenting. The extent of stenosis before and after intervention was 86.3 ±â€¯6.8% and 9.1 ±â€¯3.7%, respectively. Within 90 days after stenting, 10 patients (4.7%) experienced primary endpoint events, including 4 cases (4.2%) in the intracranial vertebral artery (V4) group and 6 (5.1%) in basilar artery (BA) group. Among them, 2 (2.1%) and 3 cases (2.5%) of ischemic stroke in V4 and BA group, respectively; and 2 (2.1%) and 2 (1.7%) cases of TIA in V4 and BA group, respectively. One (0.8%) case in the BA group dead because of the acute stent occlusion resulted in the top of the basilar syndrome. Six patients (2.8%) experienced adverse events, including 2 (2.1%) and 4 (3.4%) cases of groin hematoma in the V4 and BA group, respectively. No cases of hemorrhagic stroke, stent dislocation and vessel dissection in both groups. Our study showed that a low complication rate and a high and good revascularization rate would be achieved by the treatment of severe symptomatic atherosclerotic stenosis of the ICVBA using the stents.