Acute large vessel occlusion stroke as a neurovascular complication of immune thrombotic thrombocytopenic purpura: Mechanical thrombectomy and neurocritical care challenges
Abstract
Background: Thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy caused by severe ADAMTS13 deficiency. Although TTP is known to produce diffuse microvascular neurological injury, its presentation as an acute large vessel occlusion (LVO) stroke requiring neurovascular intervention is poorly represented in the literature. When severe thrombocytopenia accompanies acute LVO, intravenous thrombolysis is contraindicated, and mechanical thrombectomy becomes the only available revascularization strategy.
Case description: A 73-year-old woman with a 3-week history of influenza A infection presented with sudden onset of left hemiplegia, aphasia, and dysarthria (NIHSS 12). Computed tomography angiography confirmed a right proximal M1 occlusion. Thrombolysis was contraindicated due to severe thrombocytopenia (platelets 7,000/µL) and concurrent hemoptysis. The patient underwent emergent mechanical thrombectomy with thrombolysis in Cerebral Infarction 2C reperfusion. Laboratory evaluation revealed microangiopathic hemolytic anemia (Lactate dehydrogenase 1,766 U/L, schistocytes on peripheral smear, creatinine 3.0 mg/dL), and reduced ADAMTS13 activity confirmed immune TTP. Despite initiation of therapeutic plasma exchange and corticosteroids, the patient experienced progressive neurological deterioration and care was transitioned to comfort measures.
Conclusion: This case presents TTP as an underrecognized cause of acute LVO requiring mechanical thrombectomy, where…
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