Mesothelioma and internal carotid artery occlusion: acute ischemic stroke and efficacy of emergency carotid thrombectomy

Our plain-English summary of Mesothelioma and internal carotid artery occlusion: acute ischemic stroke and efficacy of emergency carotid thrombectomy, by E. Ferrero, M. Ferri, A. Viazzo, et al (Annals of Vascular Surgery, 2010).

The study

• Authors: E. Ferrero, M. Ferri, A. Viazzo, A. Gaggiano, G. Berardi, S. Piazza, P. Cumbo, F. Nessi
• Journal: Annals of Vascular Surgery
• Published: 2010;24(2):257.e9-12
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report the case of a 54-year-old man with acute stroke caused by left internal carotid artery (ICA) occlusion secondary to pleural mesothelioma, discovered later. The cranial computed tomography scan revealed a left hemisphere ischemic lesion. At neurological examination, the modified National Institutes of Health Stroke Scale (mNIHSS) score was 9. The carotid duplex scan (DS) showed a complete thrombotic occlusion of the left ICA. The patient underwent emergency carotid thrombectomy. The screening tests revealed thrombocytosis, hyperfibrinogenemia, increased C-reactive protein values, and multiple left pleural mesothelioma nodularity confirmed at the immunohistochemical investigation. After surgery, the patient's neurological symptoms improved, with an mNIHSS score of 3. At 30 and 120 days, the DS follow-up showed regular patency of the ICA.

Copyright 2009 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

In plain English

This case report, from vascular surgeons in Turin, Italy, described one 54-year-old man who arrived at hospital with an acute stroke. A brain CT scan showed a recent ischemic lesion on the left side, and his modified National Institutes of Health Stroke Scale (mNIHSS) score was 9. An ultrasound (duplex) scan showed that his left internal carotid artery was completely blocked by a clot. In an emergency operation, surgeons removed a 6 cm clot. Later tests showed a high platelet count (721,000/mL), raised fibrinogen and raised C-reactive protein. A CT scan showed multiple nodules on the left pleura, and tissue investigations suggested a mesothelioma. His mNIHSS score improved to 3, and scans at 30 and 120 days showed the artery stayed open. The authors concluded that malignant pleural mesothelioma, together with thrombocytosis and raised fibrinogen, may result in a major artery blockage. They called this an anecdotal case. The article does not mention asbestos or any exposure history.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 54-year-old man with acute stroke, treated at a vascular surgery unit in Turin, Italy (the date of treatment is not given)
• Exposure: Not reported. The article does not mention asbestos, fiber types or any occupational exposure.
• Main results:
  • Before surgery, the patient's modified National Institutes of Health Stroke Scale (mNIHSS) score was 9.
  • A duplex scan showed a complete thrombotic occlusion (blockage by a clot) of the left internal carotid artery.
  • In emergency surgery, a thrombus 6 cm long was removed from the artery.
  • Tests after surgery showed thrombocytosis, with a platelet count of 721,000/mL.
  • C-reactive protein was increased to 0.04 g/L (reference range less than 0.005 g/L).
  • A lung CT scan showed multiple left nodules on the parietal pleura, and morphological and immunohistochemical investigation results suggested a mesothelioma.
  • The day after surgery, the patient's mNIHSS score was 3. At 30 days, his arm and leg functions had totally recovered and the mNIHSS score was 3.
  • Duplex scans at 30 and 120 days after surgery showed regular patency (the artery stayed open) without thrombosis.
• The authors' conclusion: The authors concluded that, combined with hyperfibrinogenemia (raised fibrinogen), malignant pleural mesothelioma and thrombocytosis may result in a major vascular occlusion. They also concluded that restoring blood flow in an acutely blocked internal carotid artery can be achieved in the acute stage with good results even in patients with malignancy, and that timely diagnosis and treatment remain essential.
• Limitations the authors state:
  • The authors described this as a single anecdotal case.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma.

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