[Two successful thrombectomies in a patient with thrombocytopenia]

Introduction - Thrombectomy is considered to be the most effective treatment of large vessel occlusion. Until now, there are few recommendations whether thrombectomy can be safely performed in case of severe thrombocytopenia. We present a case of a 64-year-old male patient under treatment for multiple myeloma. He received lenalidomide treatment for his disease, with the known side effect of myelosuppression, leading to severe thrombocytopenia. Results - In our thrombocytopenic patient, two successful thrombectomies were performed due to the occlusion of the basilar and left middle cerebral arteries. On the control CT scan minimal bleeding was detected after the second thrombectomy. After both interventions improvement of the neurological symptoms occurred. Therapeutic anticoagulation for atrial fibrillation was restarted after platelet count had returned to the normal level. His haematological treatment was continued, with the discontinuation of lenalidomide responsible for the cytopenia and thrombogenic tendency. Investigation for thrombophilia was performed and two thrombosis predisposing abnormalities were revealed. He is currently in a good clinical condition. Discussion - In our thrombocytopenic patient, two successful thrombectomies were performed due to the occlusion of the basilar and left middle cerebral arteries. On the control CT scan minimal bleeding was detected after the second thrombectomy. After both interventions improvement of the neurological symptoms occurred. Therapeutic anticoagulation for atrial fibrillation was restarted after platelet count had returned to the normal level. His haematological treatment was continued, with the discontinuation of lenalidomide responsible for the cytopenia and thrombogenic tendency. Investigation for thrombophilia was performed and two thrombosis predisposing abnormalities were revealed. He is currently in a good clinical condition.