Intra-arterial thrombin injection of an ascending aortic pseudoaneurysm complicated by transient ischemic attack and rescued with systemic abciximab.
Thrombin injection as a means of inducing thrombus formation has recently received wide attention as an alternative treatment for pseudoaneurysm. We present a case of a 67-year-old man in whom a large mycotic pseudoaneurysm developed in the ascending aorta because of sternal osteomyelitis and mediastinitis after coronary artery bypass grafting. Transcatheter intra-arterial thrombin injection was performed, and it successfully induced pseudoaneurysm thrombosis. However, the procedure was complicated by a sudden transient ischemic attack caused by thrombus propagation into the cerebral circulation. Complete thrombus dissolution in the cerebral circulation with the resolution of neurologic symptoms was achieved by means of intravenous abciximab.
Lin
P H
PH
Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA. Peter_Lin@emory.org
Bush
R L
RL
Tong
F C
FC
Chaikof
E
E
Martin
L G
LG
Lumsden
A B
AB
D000077284:Abciximab; D000368:Aged; D017541:Aneurysm, False / Q000188:drug therapy*; D000785:Aneurysm, Infected / Q000188:drug therapy*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D017545:Aortic Aneurysm, Thoracic / Q000188:drug therapy*; D006490:Hemostatics / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D007269:Injections, Intra-Arterial; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D013917:Thrombin / Q000008:administration & dosage* / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D006490:Hemostatics; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D013917:Thrombin; D000077284:Abciximab