title: Successful recanalization of a septic embolus with a balloon mounted stent after failed mechanical thrombectomy.
abstract: Cardiac emboli are a feared complication for patients with left ventricular assist devices (LVAD). Septic emboli are rare but carry a poor prognosis in the setting of large artery occlusion. We report the case of a 24-year-old woman who presents with a left internal carotid artery terminus occlusion secondary to a septic emboli from a LVAD. The patient was not a candidate for intravenous thrombolytics due to an elevated international normalized ratio, and thus was taken for intra-arterial treatment. Initial treatment with mechanical thrombectomy and balloon angioplasty was not successful; thus, a balloon-mounted coronary stent was placed to achieve successful recanalization. Fragments of thrombus on the mechanical thrombectomy device revealed gram-positive bacilli on gram stain. Patients with large artery occlusion due to a septic embolus can be successfully treated with endovascular therapies in select patients.
authors.affiliation: Cleveland Clinic Foundation, Cerebrovascular Center, Cleveland, Ohio 44195, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Bain
authors.forename: Muhammad Shazam
authors.initials: MS
authors.lastname: Hussain
authors.forename: Vivekananda
authors.initials: V
authors.lastname: Gonugunta
authors.forename: Irene
authors.initials: I
authors.lastname: Katzan
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000800:Angioplasty, Balloon; D016470:Bacteremia / Q000209:etiology / Q000628:therapy*; D016893:Carotid Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D019233:Retreatment; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D055815:Young Adult