Forced-Suction Thrombectomy of an Arterial Tumor Embolism Due to Metastatic Melanoma

Abstract

A 22-year-old woman who had a speech disturbance for 20 minutes sought evaluation at our hospital (she had a National Institute of Health Stroke Scale score of 4). She had been diagnosed with a malignant melanoma in the left calf with multiple metastases to the brain, both upper arms, chest walls, heart, and right axillary, right supraclavicular, and right renal hilar lymph nodes (Figure, A), and she had previously undergone chemotherapy and whole-brain radiotherapy. However, her functional status was good prior to the stroke. Results from magnetic resonance imaging and angiography according to the stroke protocol showed occlusion of the left proximal middle cerebral artery. Because the 2 brain metastases were large and hemorrhagic, intravenous tissue plasminogen activator was not administered (Figure, B, and eFigure). Rather, she was transported to the angiography suite, and forced-suction thrombectomy was attempted without intra-arterial thrombolysis for fear of intracerebral hemorrhage. After several attempts with the technique, complete recanalization of the left middle cerebral artery was achieved within 30 minutes (Figure, C and D). After the procedure, her Stroke Scale score was 1 (24 hours after onset of symptoms). A pathologic examination of the clot revealed a metastasis from the malignant melanoma