Background and Purpose: Several studies reported the association between nonbacterial thrombotic endocarditis (NBTE) and Trousseau syndrome (TS). NBTE is regarded as the formation of platelet and fibrin vegetation on cardiac valves with no evidence of inflammation. We report our therapeutic experience including the mechanical thrombectomy for patients with TS and evaluate the histological findings of the retrieved clots.
Methods: Between 2011 and 2016, we treated 13 patients with TS in the department neurosurgery. Patient characteristics and clinical history were retrospectively reviewed.
Results: There were 7 females and 6 males aged 56-83 years. Cancer types were as follows: 5 were lung, 3 were bile duct, 3 were pancreas, 1 was ovary and 1 was colon. There were 12 patients with stage IV cancer. Almost patients experienced multiple infarctions in all vascular territories and there were 9 patients with occlusion of main trunk. Eleven patients had received anticoagulation treatment with unfractionated heparin by continuous intravenous drip. Seven patients were treated with oral anticoagulants. Recurrent ischemia were detected in 7 patients and 5 patients experienced the recurrence in hospital. Only 4 patients were discharged from our hospital with favorable outcome (modified Rankin Scale 2). Nine patients were confirmed dead and the average time from the onset of ischemia to death was 44 days. We performed mechanical thrombectomy for 3 patients and evaluated the histological findings of the retrieved clots from one patient. Histological evaluation showed that the clots consisted fibrin and platelets without blood cells (Figure). Transthoracic echocardiography revealed NBTE on the aortic valve of this patient. These findings suggested that NBTE was embolic source of ischemic stroke in this patient.
Conclusions: Patients with TS have an extremely poor prognosis. We demonstrated that NBTE is a main cause of cerebral artery occlusion in patients with TS.