Mechanical Thrombectomy for Methamphetamine-Associated Cardiomyopathy with Left Ventricular Thrombus: A Case Report

The global increase in methamphetamine abuse has increased the incidence of methamphetamine-associated cardiomyopathy (MACM), which is often complicated by left ventricular thrombosis and acute ischemic stroke. Here, we report a case of left internal carotid artery occlusion during acute heart failure treatment in a patient with MACM that led to mechanical thrombectomy.

A 54-year-old man with a history of approximately 30 years of methamphetamine abuse presented with dilated cardiomyopathy complicated by a left ventricular thrombus. On the night of admission for acute heart failure management, he experienced a sudden onset of consciousness disturbance, severe aphasia, and right hemiparesis. MRI revealed mild hyperintensities in the left cerebral hemisphere cortex and lenticular nucleus on diffusion-weighted imaging, with no abnormal signals on fluid-attenuated inversion recovery. He underwent mechanical thrombectomy, achieving complete reperfusion within 150 min; however, he experienced ipsilateral cerebral hyperemia that persisted for 30 days postoperatively. By the 90th postoperative day, moderate aphasia and mild paralysis of the right upper limb remained, with a modified Rankin Scale score of 3.

Left ventricular thrombosis is relatively common in patients with MACM, necessitating careful consideration of the risk of cardioembolic stroke.