Rescue Mechanical Thrombectomy After Failed Thrombolysis in a Pregnant Patient Case Report

Abstract

Pulmonary thromboembolism in pregnancy is a complication that directly impacts morbidity and mortality, the incidence is conditioned by the prothrombotic state during pregnancy and in the postpartum period, since the most important risk factor in this context is deep vein thrombosis, a condition that exponentially increases the risk of presenting thrombotic events such as pulmonary thromboembolism, in the clinical presentation there are no differences in this context, however it is important to note that to date there are no risk scales where pregnancy is included as part of the factors within a scale, so clinical diagnosis, biochemical and imaging is of vital importance, in order to reduce the potential complications and outcome of this group of patients.

In the diagnostic approach, image diagnosis such as the Transthoracic/Tranesophageal Echocardiogram is of vital importance, with the purpose of searching for etiology. It is worth mentioning that in the group of patients in whom thrombotic events of the ischemic CVD type are evident, within the diagnostic possibilities are atherosclerosis of large vessels, cardioembolism or vasculitis, in turn in the group of patients in whom evidence of thrombotic events such as PE must be ruled out the possibility of structural alterations at the level of right cavities, as well as shunts such as foramen. Patent oval, ASD, once identified, there are various Echocardiographic techniques for the detection of these conditions, such as echocardiogram with air-fluid contrast, through which morphological characteristics are visualized, being important for the assessment of direct risk, in the event of possible complications. short-medium term, such as the risk of presenting cerebrovascular events, is of vital importance when making therapeutic decisions, since once the risk is identified, surgical/percutaneous therapeutic options are available, according to the patient's context.

In the present case, reference is made to a young patient whose main risk factor is Pregnancy 10.5 SDG, and whose initial presentation to the case was pulmonary thromboembolism of main branches, secondary to deep vein thrombosis, in which thrombolysis was performed with rtPA, continuing with data of hemodynamic instability for which invasive treatment was decided by mechanical thrombectomy with an immediate favorable response, in turn presented a second thrombotic event, of the Ischemic cerebrovascular event type in the territory corresponding to the posterior cerebral artery secondary to a patent foramen ovale. with a favorable outcome after timely multidisciplinary treatment